The Biden administration released a proposed rule that will govern how private health plans must operate in 2023 and in doing so, took some steps to limit patient cost-sharing for prescription drugs. However, despite the urging from patient groups, they are not requiring insurers and pharmacy benefit managers (PBMs) to count copay assistance towards patient out-of-pocket cost-sharing and deductibles.
The “Help Ensure Lower Patient Copays Act” would ban a cruel practice implemented by insurance companies that accept a patient’s copay assistance but does not apply it to the patient’s deductible and out-of-pocket cost obligations. This leaves the patient with potentially thousands of dollars in unanticipated costs.
The HIV+Hepatitis Policy Institute (HIV+Hep) and American Autoimmune Related Diseases Association (AARDA), along with 38 other patient organizations, filed comments earlier this week with the U.S. Department of Health and Human Services (HHS) addressed to Secretary Xavier Becerra that urge HHS to improve the affordability of prescription drugs for patients in the private insurance market through Standard Benefit Plans.
“We are deeply disappointed that CMS passed on addressing the issue of copay assistance for prescription drugs and requiring insurers and pharmacy benefit managers (PBMs) to count assistance towards patient out-of-pocket cost-sharing and deductibles,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.
Trump Administration fails to protect patient affordability of medications: Biden Administration must step in to improve affordability
Washington DC… Today, the Trump administration rushed out the partial release of the rules that govern how private health plans must operate in 2022 and in doing so…