If the administration does not act, patients nationwide will continue to be subject to schemes that lead to higher out-of-pocket costs for the medications they need, risking medical debt or facing treatment delays and lack of adherence. To protect patients, essential health benefits drugs must be rightfully treated with the gravity that their name implies—medications that are “essential” to a healthy life for patients.
For years, greedy insurers and PBMs, who have been in the news lately, have used copay accumulators and other nefarious tactics to inflate patient costs and increase their profits. It’s time for President Biden, Vice President Harris, and Secretary Becerra to do something about it.
Among Americans who take prescription drugs, a quarter struggle to afford their medication. For those who are in poor health or have low incomes, the portion is even higher. These days, the rising cost of everyday goods and services is forcing more people to face difficult decisions and ask themselves: How can I pay for utilities, the groceries, or the medicine that’s keeping me alive? Now imagine that someone offers you financial assistance for the express purpose of paying for your medicine—problem apparently solved. But in a cruel twist, your health insurer pockets that assistance, without counting it toward your annual deductible or out-of-pocket maximum. That’s why the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed suit in federal court, challenging the Trump-era federal government rule that allows insurers and pharmacy benefit managers to carry out this harmful practice.
The silent tragedy of the COVID-19 pandemic is its devastating impact on people with other health conditions. For those illnesses, declining attention has persisted even as the threat of COVID-19 is declining. HIV provides a striking example of the setback — and how the effects are looming in the shadows. In December, President Biden set a goal of reducing new HIV infections to just 3,000 a year by 2030, a decline of more than 90 percent from current levels. That goal is achievable as long as Congress and the administration are putting the right policies in place and people can access and afford their medications.
President Biden has repeatedly promised to make health care more affordable. And his administration has taken some important steps. But sadly, officials at the Centers for Medicare and Medicaid Services just passed up an opportunity to save patients millions at the pharmacy.