3 Ways Policymakers Can Act
The Centers for Medicare & Medicaid Services (CMS) can reverse the previous administration’s 2021 Notice of Benefit and Payment Parameters (NBPP) rule that allowed health insurance plans to adopt copay accumulator adjustment policies. This policy change is inconsistent with important financial protections promised by the Affordable Care Act, which defines cost-sharing as “any expenditure required by or on behalf of an enrollee with respect to essential health benefits…” (Section 1302(c)(3)). We urge CMS to enact these changes to protect patients.
FEDERAL LEGISLATIVE ACTION
The Help Ensure Lower Patient Copays Act (HELP Copays Act) was created to stop the abusive practices of PBMs and health insurers. This bipartisan legislation would bring much-needed relief to financially vulnerable patients by ensuring that all payments—whether they come directly out of a patient’s pocket or with the help of copay assistance—count towards their out-of-pocket costs. This legislation would also close the essential health benefits loophole.
We encourage Congress to include the HELP Copays Act in any PBM reform package. This bill provides immediate financial relief to patients with serious, complex, chronic and rare diseases, a necessary component to any PBM reforms that come to the floor.
STATE LEGISLATIVE ACTION
Nineteen states have already acted to protect patients. States have authority to block accumulator adjustor policies in state exchanges and certain private health insurance plans. Although not all patients are protected by these laws, and a federal solution is still needed, these state actions are helping millions of patients.