The Department of Health and Human Services through the Centers for Medicare and Medicaid Services (CMS) announced last week new regulations establishing standardized health plan options and refining the non-discrimination policy, measures that will make healthcare more accessible and affordable.
The PAN Foundation was disappointed however, that the final 2023 Notice of Benefits and Payments Parameters (NBPP) rule failed to address harmful co-pay accumulator policies, which reduce access to critical and often life-saving prescription medications.
Each year, CMS issues the NBPP, a set of rules and regulations that guide health insurance marketplaces and plan designs for the following year. There is a comment period after the draft rule is introduced, during which individuals and organizations can offer feedback to CMS.
The PAN Foundation submitted feedback on the proposed rule earlier this year, urging HHS and CMS to include a provision to ensure all co-pay assistance counts toward a patient’s deductible.
The problem with co-pay accumulators
Co-pay accumulator policies financially benefit insurance issuers and pharmacy benefit managers, while making crucial treatments unaffordable for patients. These programs can prevent financial assistance from counting toward a patient’s deductible.
Co-pay assistance is financial assistance provided by manufacturers, charitable assistance foundations, or from a family member that helps a patient pay for their co-pays and co
–insurance. When that assistance is not counted toward a patient’s deductible and out-of-pocket costs, the patient alone is left responsible for paying what is often an exorbitant amount in out-of-pocket costs.
“Simply put, co-pay accumulators are leading to poor health outcomes,” said PAN Executive Vice President Amy Niles. “While I commend HHS and CMS on the approved provisions that limit patient cost-sharing and standardize plans, they haven’t gone far enough. Patients will still rely on financial assistance to stay on their prescribed medications. And left unchecked, co-pay accumulators will continue to get in between patients and their life-sustaining medications.”
Positive changes for patients in the NBPP
The PAN Foundation applauds these provisions in the 2023 approved NBPP:
- Establishing standardized plan options, with standardized maximum out-of-pocket limitations, deductibles, and cost-sharing features that will provide consumers an easier way to compare plans, including premiums, provider networks, prescription drug coverage, and quality ratings. They also include simpler cost-sharing structures that will allow consumers to more easily understand their coverage.
- Updating the CMS nondiscrimination policy, making it more difficult to limit coverage for essential health benefits on a basis protected from discrimination, such as age or health condition.
Read the full HHS announcement to learn more about all provisions in the 2023 approved NBPP.
About the PAN Foundation
The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.
Since 2004, we have provided more than 1 million underinsured patients with $4 billion in financial assistance. Partnering with generous donors, healthcare providers, and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.
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