New U.S. Department of Health and Human Services rule to allow copay accumulator programs will hurt vulnerable patients

Washington, D.C., May 11, 2020—In a significant setback for patients, the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services (HHS) announced last week a package of new regulations for Affordable Care Act health insurance plans that will significantly increase out-of-pocket costs for patients who rely on prescription medications for life-threatening, chronic and rare diseases.  

Starting in 2021, insurers providing plans under the Affordable Care Act will not be required to count assistance from drug manufacturers toward patients’ annual deductibles or other out-of-pocket costs.

“The PAN Foundation strongly opposes the new rule from the U.S. Department of Health and Human Services to allow copay accumulator programs,” said President and CEO Dan Klein.

“Patients who rely on prescription medications for serious and chronic health conditions may see a sharp increase in their total out-of-pocket costs next year. This is gravely concerning given that 21 million people are newly unemployed due to the COVID-19 pandemic and rely on these healthcare plans to access essential medical treatment.”

During the consideration of this new rule, the PAN Foundation joined the All Copays Count Coalition in submitting comments to HHS to advise federal regulators on the harm patients experience when health plans prevent copay assistance from drug manufacturers from counting toward their total cost-sharing obligations.

With so many patients facing steep economic insecurity as a result of COVID-19, the PAN Foundation also joined the All Copays Count Coalition in early May to urge HHS to reconsider its proposal.

Drug manufacturer coupons help underinsured patients with commercial insurance afford their prescription medications.

When health insurance plans implement copay accumulator programs, they prevent patients from using the assistance received from drug manufacturers to count toward their annual deductibles and out-of-pocket drug costs, resulting in a much larger financial burden for their medications.

“While health insurers have argued that copay accumulator programs prevent manufacturer assistance from driving up drug prices, no meaningful solutions have been offered to make out-of-pocket costs more affordable for seriously ill patients,” adds Klein. “These patients do not have the option of taking generic or less expensive brand drugs.”

MEDIA Contact

Liz Eckert
Director of Marketing and Communications