WASHINGTON, D.C. – April 29, 2022 – In response to final rulemaking for the Centers for Medicare & Medicaid Services’ (CMS) Notice of Benefit and Payment Parameters (NBPP) for 2023, the All Copays Count Coalition (ACCC), which comprises more than 80 groups representing patients with serious and chronic health conditions, today released the following statement:
“The All Copays Count Coalition is extremely disappointed that the final NBPP for 2023 does not include a provision disallowing the use of copay accumulator adjustment policies. These policies disproportionately harm financially vulnerable patients living with serious chronic health conditions. CMS has once again failed to reverse a rule created by the previous administration that undermines the cost-sharing protections established by the Affordable Care Act (45 CFR 155.20 and 156.130). This lack of action runs contrary to the Biden Administration’s stated goals of increasing access to care and protecting American families from extraordinary medical costs and medical bankruptcy. At a time when food, gas and housing costs are soaring, taking action on accumulators is a practical and meaningful way to bring relief to patients who for far too long have been forced to choose between medical care and basic needs.
“Given that CMS has not taken steps to restrict the use of accumulator adjustment policies, urgent action by Congress is needed to protect patients. We are grateful for increasing bipartisan support of the Help Ensure Lower Patient (HELP) Copays Act (H.R. 5801), which seeks to eliminate harmful copay accumulator adjustment policies and protect patients. We urge lawmakers to pass this commonsense solution to eliminate barriers to lifesaving and affordable care.”
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About the Issue
Millions of patients who depend on financial assistance to afford their medications are being told that the money must come out of their own pocket before they can get their medications. Health plan policies called copay accumulator adjustments no longer count financial assistance toward the patient’s annual deductibles or their out-of-pocket maximum. First the patient’s copay assistance covers out-of-pocket costs at the pharmacy; and then, when the assistance runs out, the patient has to pay what the manufacturer assistance already covered for their deductible or out-of-pocket maximum. Patients only use copay assistance for medications they’ve been prescribed after less expensive options did not work, and they have no alternative. Most drugs that offer copay assistance are brand drugs that do not have a generic alternative. Copay accumulator adjustor policies hurt patient access to medicines, decrease drug adherence, and even cost our health care system more money.
About the All Copays Count Coalition
The All Copays Count Coalition (ACCC) includes The AIDS Institute, the Arthritis Foundation, the Cancer Support Community, the National Hemophilia Foundation, the National Multiple Sclerosis Society, the Immune Deficiency Foundation, and more than 80 other groups serving the interests of patients with chronic and serious health conditions that rely on copay assistance in various forms to make medically necessary drug treatments affordable.