PAN submits comments to CMS on the 2026 Notice of Benefit and Payment Parameters proposed rule
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In a letter to the Centers for Medicare & Medicaid Services, the PAN Foundation urged the administration to address the $10,000 annual out-of-pocket limitation on cost-sharing for Affordable Care Act (ACA) plans. PAN provided a methodology comparison that shows the annual maximum out-of-pocket limit for ACA plans is increasing more rapidly than employer-based Health Savings Account-qualified plans-and faster than wages and salaries for most Americans.
In addition, PAN voiced strong support for a revision instituted last year that requires plans to count all prescription drugs as Essential Health Benefits for cost-sharing purposes and encouraged enforcement of this policy to protect patients and strengthen health equity. PAN also urged the administration to issue a proposed rule that would apply this revision rule to large group and self-insured plans.
In summary, PAN strongly urged CMS to lower the maximum out-of-pocket limit and require insurers and pharmacy benefit managers to include copay assistance payments in their calculation of an enrollee’s out-of-pocket limit will provide our most vulnerable with the protections they need. Additionally, CMS must prohibit the harmful strategies by plans of designating certain drugs as non-essential health benefits and then collecting the copay assistance from drug manufacturers and the growing practice of alternative funding programs.