As Congress considers reforms to private health insurance, we urge you to ensure that coverage provides meaningful access to the medications, services, and care patients need and protects them from practices that shift costs or create unnecessary barriers to treatment.
We write to express our support for the proposed settlement with with Caremark Rx, L.L.C. and Zinc Health Services, LLC to highlight several provisions that will significantly improve affordability and access to medications for patients and propose critical enhancements to further strengthen the order’s protections.
HIV+Hepatitis Policy Institute and the Arthritis Foundation sent a letter to PCMA raising concerns about how its members will present TrumpRx prices to insured patients. The groups urged PCMA members to clearly disclose whether TrumpRx purchases will count toward patients’ deductibles and out-of-pocket maximums, warning that a lower cash price today could ultimately result in higher costs over the course of the plan year.
This rulemaking is the first opportunity to codify the Negotiation Program in binding regulatory text rather than annual sub-regulatory guidance, and codification is the appropriate moment to close these gaps. Patients were promised that this program would deliver meaningful affordability and access improvements, and CMS should use this rulemaking to make good on that promise through enforceable, not merely discretionary, standards. Our comments address patient engagement in the negotiation process, transparency in how patient input is used, formulary access and utilization management protections for selected drugs, and additional concerns about the negotiation methodology itself.
Drug-pricing policies should be evaluated based on whether they reduce what patients pay at the point of care without undermining access to treatment or the safety-net programs on which underserved communities rely.