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.
HIV+Hep strongly supports the “Copay Accumulator Amendment Act of 2021” (Bill 25-0141). It simply requires that the copay assistance beneficiaries receive counts towards their out-of-pocket obligation. By signing this law, DC will join 17 other states (Arkansas, Arizona, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, Oklahoma, New Mexico, North Carolina, New York, Tennessee, Washington, West Virginia, and Virginia) and Puerto Rico in protecting consumers by assuring their copay assistance will count towards cost-sharing obligations.
We voice our strong support for Senate Bill 0799 (“Relating to Insurance–Prescription Drug Benefits”) which would require health insurers to accept and count payments made on behalf of patients towards deductibles and out-of-pocket maximums. We thank you for holding a hearing on this important issue and ask that you pass the bill as soon as possible.
We strongly support your bipartisan leadership in taking action to address some of the abusive practices Pharmacy Benefit Managers (PBMs) engage in that hinder patient access and the affordability of prescription drugs. While most people think insurers make the majority of decisions regarding health coverage and affordability, when it comes to prescription drugs, it is PBMs that drive many of the decisions as to what medications a beneficiary can access and how much they pay for them.