Patients Deserve Better:

HHS Proposed Rule Increases Patients’ Out-of-Pocket Costs for Medicines and Undermines Health and Wellness

UPDATE: On Thursday, May 7, 2020, the U.S. Department of Health and Human Services decided to move forward with a rule that allows health insurers not to count copay assistance toward out-of-pocket maximum limits for medications. Given all the uncertainties resulting from COVID-19, patients deserve better. Click here for the AARDA statement, and see additional information below.

 

In late January, the Department of Health and Human Services proposed a draft rule that would expressly allow insurance plans to exclude drug manufacturer copay assistance from counting towards patients’ annual limitation on cost sharing. In addition, the proposed rule would interpret the definition of “cost sharing” as not including expenditures covered by such assistance.

If this proposal is finalized, it would result in major financial setbacks for patients and create undue interference with the physician-patient relationship. Negative effects also would likely result with respect to patients’ access to prescribed therapies and medication adherence. We also are concerned that the proposed changes are inconsistent with the Administration’s promise to make prescription drugs more affordable for patients.

What’s at stake?

map-icon
map-icon

What’s at stake?

In short, a lot. Millions of Americans rely on various forms of financial assistance—including but not limited to manufacturers—to help access the treatments prescribed by their physicians. Policies that exclude certain types of assistance from counting towards patients’ annual limitation on cost sharing effectively increase patients’ out-of-pocket costs, which, in turn, can create significant barriers to access and undermine patients’ ability to adhere to prescribed treatment regimens. Indeed, patients’ inability to cover out-of-pocket costs can result in the foregoing of (or inability to access) reliable treatments, causing exacerbated conditions, irreparable damage, unnecessary suffering, and additional costs.

Who will be affected?

person-icon
person-icon

Who will be affected?

This policy change under the proposed rule, if finalized, would be particularly harmful to patients with autoimmune and other chronic conditions who need highly personalized care from physicians who understand their unique health situations. To help address these types of access restrictions, AARDA convened Let My Doctors Decide, a national coalition that is bringing together doctors and patients who recognize the importance of preserving the physician-patient relationship and advocating for policies that promote access to medically necessary care—not policies that create barriers between physicians and their patients based on non-medical considerations. The proposed policy to allow insurers to exclude manufacturer copay assistance amounts from a patient’s out-of-pocket cost-sharing limitation is a preventable and unnecessary access restriction.

We need to be working together to help patients obtain and maintain access to their doctor-prescribed medicines, not imposing policies that create additional barriers and prevent people from achieving positive health outcomes.

Your Voice Matters!

megaphone-icon
megaphone-icon

Your Voice Matters!

A few key notes:

  1. We recently drafted a sign-on letter and joined with 43 leading organizations to communicate our opposition to these proposed changes under the proposed rule. Click below to download the letter that we submitted prior to the HHS deadline.
  2. While the official HHS comment period is closed, we would like to hear from you! If you have comments, stories, or any additional information that can help us understand how this proposed rule would impact you or your community, we’d love to hear them. You can reach us directly at [email protected].
  3. Check back frequently for updates, and be sure to speak up on your social networks and by informing friends, colleagues, and family members on the harmful effects of this proposal.