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Federal Proposals Endanger Patients and Hike Up Costs for the Chronically Ill

October 12, 2020
By Liz Helms
Inside Sources

As a nation, shouldn’t we try to make healthcare more affordable and accessible?

Yet, recent health policies continue to fail vulnerable individuals, like those living with chronic illness. These patients — who pay thousands in out-of-pocket costs each year due to specialty doctors, increased office visits, multiple medications and regular testing — live in constant fear of the next unexpected cost that would make managing their health condition even more challenging.

Unfortunately, a pair of health policy changes, one enacted and one proposed, do just that.

The first is the recently enacted Centers for Medicare and Medicaid Services (CMS) 2021 Notice of Benefit and Payment Parameters (NBPP). This rule allows private health insurers to implement copay accumulators, excluding co-pay assistance programs like cards or coupons from counting towards a patient’s deductible and out-of-pocket maximums.

The worrisome policy means patients will be left paying higher costs, oftentimes for life-saving medications.

In the middle of a pandemic, a patient shouldn’t have to worry about accessing medications for their condition and fearing for their health due to poor policy. Unfortunately, it is expected health plans will quickly adopt the ill-advised NBPP policy.

Already, health plan deductibles are high and, in many cases, increasing. Just this year, the average deductible for a 40-year-old with a Bronze plan increased 4 percent to more than $6,000.

And according to a May 2019 survey conducted by the Kaiser Family Foundation and the Los Angeles Times, a stunning 75 percent of adults with the highest deductible health plans reported that a family member living with chronic illness had to skip or delay taking prescription medications or seeking medical care due to the high costs.

Another concerning federal proposal that will increase costs for patients is the U.S. Department of Health and Human Services’ (HHS) proposed rule for Medicaid (Medi-Cal in California).

This misguided policy intends to guarantee patients receive financial discounts for medications but requires drug manufacturers, rather than insurers, to ensure these benefits reach patients.

Unfortunately, drug manufacturers, unlike insurers, cannot control where the assistance is applied which makes compliance with this provision impossible.

As a result, drug manufacturers could have to change or reduce their financial assistance programs, leaving patients with higher costs and potentially eliminating many of these life-saving programs.

While the NBPP and Medicaid rules are ill-advised in their own right, these policy changes are particularly cruel when coupled with the pandemic.

Millions of people who have lost jobs or have seen their incomes slashed will now face unprecedented health cost increases, making it even harder for them to afford the medications and treatments they so desperately need.

There is some good news.

Throughout the pandemic, grassroots advocacy has exploded. Patient advocates across the country have urged Congress to delay the implementation of the NBPP policy until at least 2022 and ensure co-pay assistance will continue to count toward patient out-of-pocket costs.

This delay would allow CMS time to gather critical stakeholder input on the impacts of this policy and to better understand how patients rely on cost-sharing assistance to afford the very medications they need to stay healthy and live productive lives.

It will also protect patients from being blind-sided by unexpected costs as copay accumulator programs are adopted by their health plans.

As a result of this outreach, a bill has been introduced in the House of Representatives that would do just that — delay this rule and allow for more analysis and prevent harm to patients. We urge Congress to support and pass this legislation.

We also urge HHS to drop this harmful Medicaid proposal and find a workable way to ensure that patients receive the rebates intended to lower their out-of-pocket costs.

The last thing patients need right now — during a massive public health crisis — is less access to affordable, innovative medications.

Healthcare reform is supposed to make care more affordable and accessible, but the above proposals only risk the lives of the vulnerable patients they should be protecting. Our policymakers have the chance to listen to the needs of their constituents.

We hope they do.