Trump Administration fails to protect patient affordability of medications: Biden Administration must step in to improve affordability

Press Release

January 14, 2021

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, failed to protect patient affordability of prescription drugs.

“We are deeply disappointed that CMS neglected to address the issue of copay assistance for prescription drugs and to require insurers and pharmacy benefit managers (PBMs) to count it towards patient out-of-pocket cost-sharing and deductibles,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Even before COVID-19, patients were struggling to afford their medications and relied on copay assistance from drug manufacturers. Now, the need is even greater. This rule needs to be redrafted by the incoming Biden administration in such a way that it will improve patient affordability.”

In comments submitted by HIV+Hep on the draft Notice of Benefits and Payment Parameters rule, we asked that CMS require plans to count copay assistance due to the increased level of out-of-pocket costs, which will be a whopping $9,100 for an individual and $18,200 for all others in 2022. We also discussed the growth of high-deductible plans, the impact of cost-sharing on adherence, and the lack of transparency by insurers of their copay policies.

In the rule that governs health plans in 2021, CMS indicated that if plans were not transparent in their policies, they would consider future rulemaking. Unfortunately, CMS has not yet paid attention to the comments submitted by HIV+Hep in which we provided several examples of 2021 plans and their hidden and ambiguous copay assistance policies.

For example, HIV+Hep noted that Florida Blue buries their very ambiguous copay policy language on page 47 of a 144 page Plan Contract that reads, “We may not apply manufacturer or provider cost share assistance program payments (e.g., manufacturer cost share assistance, manufacturer discount plans, and/or manufacturer coupons) to the Deductible or Out-of-Pocket maximums.”

CMS indicates that it will consider additional issues included in the public comments as part of a second final rule that will be published in the future.

“People are rightfully complaining about how much they pay for prescription medications. We hope the Biden administration will soon address insurance benefit design and patient cost-sharing. They can begin by requiring copay assistance for prescription drugs to count,” concluded Schmid.

In 2018, drug manufacturer copay assistance for patients totaled $13 billion, according to data from IQVIA.

Jennifer Burke
(301) 801-9847

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