HHS final rule will increase healthcare access but fails to address harmful copay accumulators

The PAN Foundation today, expressed appreciation for several provisions in the latest Notice of Benefit and Payment Parameters (NBPP) final rule that will increase equitable healthcare access, but was disappointed that once again, the final rule did not address harmful copay accumulator programs.

Each year, the Centers for Medicare & Medicaid Services (CMS) propose, review, and eventually finalize the rules and regulations that guide the operation of the federal healthcare Marketplace. The U.S. Department of Health and Human Services (HHS) NBPP final rule, issued this week, outlines the final updates for 2024.

“Many of the changes outlined in this final rule will increase equitable access to healthcare services, and we applaud every change that removes barriers to care,” said PAN President and CEO Kevin L. Hagan. “However, it’s disappointing that another opportunity has been missed to protect patients from predatory copay accumulator policies. These programs disproportionately impact patients with low incomes and who need expensive medications. We will continue to push for regulations and legislation that ensure all copay assistance counts toward a patient’s annual deductible.”

PAN expressed appreciation for the following provisions in the final rule:

  • All Marketplace qualified health plans, with limited exception, will be required to use a network of healthcare providers so that people with these health insurance plans have choices when seeking medical care and can easily learn more about their in-network options.
  • Marketplaces will have the option to offer a 90-day special enrollment period for people who are losing coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Medicaid and CHIP have a 90-day reconsideration period to appeal lost coverage, and CMS hopes that aligning these periods will minimize gaps in healthcare coverage.
  • Trained professionals who help people evaluate health plan options through the Marketplace, known as assisters, will now be allowed to help people enroll in health plans during their first meeting. Currently, assisters can conduct outreach, educate, and schedule follow-up appointments, but cannot help people enroll in a health plan during their first meeting. CMS recognized that this limitation was a barrier to access that prevented timely enrollment help.

Unfortunately, the final rule did not prohibit or address harmful copay accumulator programs. Many patients with chronic health conditions turn to financial assistance programs like PAN to afford their out-of-pocket prescription medication costs, which provide a critical lifeline for thousands of people each year. Commercial insurance copay accumulator policies that prevent patients from using this financial assistance to count toward their deductibles result in a much larger overall out-of-pocket financial burden for many and must be addressed.

Learn more about PAN’s advocacy efforts and policy positions.

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.