We believe policymakers should focus on those issues that directly impact patients, such as PBM regulation and reform, standard plan designs with reasonable deductibles and nominal copays, and ensuring copay assistance counts. We realize that Illinois has taken many of these steps already, and that Illinois policymakers are advocating for change at the national level, too, but more can be done.
It is a pleasure to voice our strong support for Senate Bill 844 (“Requires any amount paid on behalf of a health benefit plan enrollee to count toward the enrollee’s cost-sharing”) which provides that when calculating an enrollee’s overall contribution to an out-of-pocket max or any cost-sharing requirement under a health benefit plan, a health carrier or pharmacy benefits manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee for any medication for which a generic substitute is not available. We thank you for holding a hearing on this important issue and ask that you consider and pass the bill.
It is a pleasure to voice our strong support for Senate Bill 354-FN (“relative to insurance cost-sharing calculations”) which would require health insurers and pharmacy benefit managers to include any amount paid by the enrollee or on their behalf in calculating an enrollee’s contribution to cost-sharing requirements. We thank you for holding a hearing on this important issue and ask that you consider and pass the bill.
We appreciate all you are doing to make healthcare more accessible and affordable for beneficiaries, including several proposals contained in the proposed rule. While we support several of them, this letter focuses on those issues that impact access and affordability of prescription drugs.
The HIV+Hepatitis Policy Institute submitted comments recommending that the 2025 Draft Letter to Issuers in the Federal-facilitated Exchange include a reminder to issuers that copay assistance must be counted for all but brand name drugs with a generic equivalent, plans be flagged for adverse tiering when all or a majority of drugs to treat a certain condition are on the highest tiers, CMS takes a more proactive role in enforcement action against insurers that violate the law, and CCIIO fully reviews plans for benefit designs that discriminate against certain individuals.