McEachin Fights to Keep Out-of-Pocket Prescription Drug Costs Lowered by Maintaining Existing Co-Pay Assistance Policies
WASHINGTON, D.C. – Rep. A. Donald McEachin (D-Va.) yesterday led more than 70 of his House colleagues in writing to U.S. Department of Health and Human Services (HHS) Secretary Alex M. Azar II, expressing strong opposition to portions of the recently released 2021 Notice of Benefit and Payment Parameters (NBPP) proposed rule
Historically, when a patient utilizes cost-sharing assistance at the pharmacy counter, the amount counts towards a patient’s deductible and maximum out-of-pocket limit. In 2019, HHS reversed that policy, allowing health insurers to exclude manufacturer assistance from patients’ deductibles and out-of-pocket limits. At a time when millions of Americans struggle already to pay their pharmacy bills, Congressman McEachin and his colleagues are concerned that the potential changes would force patients to pay even more for life-saving and life-enhancing prescriptions.
“With patient out-of-pocket costs skyrocketing, we oppose any regulatory changes that would hinder patients’ ability to afford their medicines,” wrote Congressman McEachin and his colleagues in the letter. “It is our fear that many patients will opt to ration their medicines, or leave their medications at the pharmacy counter altogether, which could lead to more serious health conditions and higher costs. This stands to have a disproportionate impact on individuals from vulnerable populations, people of color, and those with lower incomes and poorer health. We should be doing everything we can to increase affordability options, not limit them.”
Nearly eight in 10 Americans say they spend too much on prescription drugs. Pharmacy costs are particularly high for Americans battling autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, lupus and HIV. To treat these and other chronic conditions requiring multiple specialty drugs that can cost thousands of dollars each, patients often rely on coupons sent by drug manufacturers to bridge the financial divide to access their medication. Last year, the Commonwealth of Virginia became the first state to bar insurers from excluding drug manufacturer copay assistance from counting towards a patients’ deductible or out-of-pocket limit.
“Members of Congress on both sides of the aisle agree: Americans shouldn’t have to choose between paying for the medication they need and their next meal,” said Congressman McEachin. “Building on the commonwealth’s success in ensuring prescriptions remain accessible to patients who need them, I am pleased to lead my colleagues in this letter urging Secretary Azar to ensure the same protections are available on the federal level to Americans struggling to pay soaring prices at the pharmacy counter.”
“We urge you to reconsider finalizing the 2021 NBPP’s misguided policy on cost-sharing assistance and ensure that provisions pertaining to consumer out-of-pocket costs are consistent with the 2020 NBPP’s policy,” the letter continued. “We believe this would help patients continue to afford their medicines by requiring cost-sharing assistance to count towards patients’ out-of-pocket maximum when a medically appropriate generic equivalent is not available.”
Full letter text is available here.
For more information, please contact:
Ralph M. Jones, Jr., Communications Director
U.S. Representative A. Donald McEachin (VA-04)