Today, the HIV+Hepatitis Policy Institute (HIV+Hep) and the Autoimmune Association, along with 103 other organizations representing a broad range of patients across the country, submitted comments to the Federal Trade Commission (FTC) in response to a Request for Information (RFI) on the impact of pharmacy benefit manager (PBM) practices and the ability of patients to access and afford their prescription medications.
Biden administration takes big step in making drugs affordable for patients: Also strengthens nondiscrimination protections
In reaction to the Biden administration’s announcement today that insurers on the federal exchange must offer standard plans, which for the most part use reasonable copay limits for prescription drugs, Carl Schmid, executive director, HIV+Hepatitis Policy Institute (HIV+Hep), issued the following statement: “This is a huge win for patients. Insurers have made it almost impossible for patients to afford their medications by first requiring them to meet a high deductible and then charging high co-insurance, which is a percentage of the list price of the drug. By limiting patient copays and keeping more drugs outside of the deductible, patients will be better able to afford their medications. We only wish the Biden administration would have applied these principles to more metal levels and drug tiers, but this provides better options for people who rely on prescription drugs.”
The HIV+Hepatitis Policy Institute and the Autoimmune Association, along with 45 other patient organizations, submitted comments to the U.S. Department of Health and Human Services (HHS) on the Notice of Benefits and Payment Parameters (NBPP) for 2023 proposed rule. The sign-on letter applauds the Biden administration for efforts to make drugs more affordable for patients by requiring insurers on the federal exchange to offer standardized plans with copays rather than co-insurance. However, the groups urge HHS to make improvements to the standard plans in the final rule by increasing the number of drugs not subject to a deductible and lowering some copay amounts.
Biden administration begins to address patient affordability of medications: but fails to ensure copay assistance counts as patient cost-sharing
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.