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The PAN Foundation applauds HHS proposed rule, but disappointed co-pay accumulators not addressed

In response to a newly released 2024 Notice of Benefit and Payment Parameter Proposed Rule from the U.S. Department of Health and Human Services, the PAN Foundation is grateful for the administration’s commitment to increasing access to healthcare services, simplifying choices, and making it easier to enroll in coverage.

The proposed rule, which is open for public comment for 45 days once published to the Federal Register, takes important steps towards increasing provider choice, advancing health equity, and expanding access to care—especially for those who are low income, have chronic health conditions, or reside in underserved areas. In addition, it proposes actions that would simplify and improve the plan selection process, while also making it easier to enroll in coverage.

However, the proposed rule does not go far enough when it comes to addressing a key affordability issue—the prohibition of copay accumulators. Many patients with chronic health conditions turn to financial assistance programs to afford their out-of-pocket prescription medication costs, which serve as a critical lifeline for thousands of people each year. Commercial insurance co-pay 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.

“We are grateful for any actions that help make healthcare more accessible for all,” said PAN Foundation Chief Advocacy and Engagement Officer Amy Niles. “But while we applaud the important steps this proposed rule does take, we are disappointed that it does not clarify that insurers must count any assistance paid by or on behalf of a patient toward their annual deductible and out-of-pocket limit. Alongside our partners and patient advocacy organizations, we are committed to advocating an end to these harmful, discriminatory policies, known as co-pay accumulators, that disproportionately impact lower-income patients and those who require expensive medications to treat their chronic, rare, or life-threatening health conditions.”

In addition to providing financial assistance to help cover out-of-pocket costs for underinsured people, PAN works alongside partners, coalitions, and patient advocates to build long-term policy solutions that improve healthcare access and affordability so that people can live the lives they deserve. Learn more about PAN’s advocacy efforts and position statements.

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.