Bad Medicine Prescribed by the Trump Administration, Putting Health Insurers before Patients

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Earlier this week the Centers for Medicare & Medicaid Services ("CMS") issued the final Notice of Benefit and Payment Parameters for the 2021 benefit year, also referred to as the 2021 Payment Notice. CMS hailed the announcement as continuing "the Trump Administration's efforts to promote affordability, improve consumer choice, ensure program integrity, and increase market stability," yet it was met with strong criticism from the patient advocacy community. The ADAP Advocacy Association blasted the Trump Administration for putting the deep pockets of the health insurance industry before the needs of patients living with chronic health conditions, such as HIV/AIDS.

Photo Source: Patients Rising Now

Most troubling for patients is the decision allowing health insurance companies to disallow drug manufacturer co-pay assistance programs towards patient out-of-pocket cost sharing and deductibles.
Co-pay savings programs are offered by drugmakers, thereby reducing out-of-pocket costs for patients. Some programs, such as co-pay coupons are typically for "expensive, brand name drugs without a generic equivalent" (Chase, 2019).

According to a statement issued by Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, "In 2018, drug manufacturer copay assistance totaled $13 billion, according to data from IQVIA. The new rule is a complete reversal of the administration's policy announced last year that required copay assistance to count for brand name drugs that do not have a generic."

That sentiment was echoed by Bill Remak, chair of the International Association of Hepatitis Task Forces: "This is a major setback for patients living with viral hepatitis and related diseases and will effectively raise patient costs and reduce access to critical medications. On behalf of the millions of people living with viral hepatitis, we urge the Trump Administration to reverse this rule and not adopt policies that do not count copay assistance toward their deductible and annual out-of-pocket limit. With the COVID-19 pandemic, this move creates even more barriers preventing patients from getting the medications they need."

Twitter also was filled with condemnation from the patient advocacy community, including rebukes from the Community Access National Network (CANN) and The AIDS Institute.

The PAN Foundation warned disallowing co-pay accumulator programs will hurt vulnerable patients by shifting the cost burden over to them.

According to Patients Rising Now ("PRN"), "patient assistance programs are providing free medications, expanding patient support services and increasing access to care as a way to help millions of patients struggling to pay the bills during the COVID-19 pandemic." PRN characterized the decision by CMS as flawed and asked that they reconsider the final rule.

The All Copays Count Coalition - representing a broad spectrum of patient groups - sent a letter to HHS Secretary Azar prior to the final rule urging HHS to reconsider the co-pay provision. It obviously fell on deaf ears because the Trump Administration sided with the greedy health insurers rather than the patients who need the financial assistance.

A copy of the 2020 Final Payment Notice can be downloaded online: https://www.cms.gov/newsroom/press-releases/cms-announces-final-payment-notice-2021-coverage-year.

References:

• Chase, Lauren (2019, September 16). What Are Manufacturer Copay Cards? GoodRx. Retrieved online at https://www.goodrx.com/blog/what-are-manufacturer-copay-cards/. 
• Centers for Medicare & Medicaid Services (2020, May 7). CMS Announces Final Payment Notice for 2021 Coverage Year. Retrieved online at https://www.cms.gov/newsroom/press-releases/cms-announces-final-payment-notice-2021-coverage-year.
• Remak, Bill (2020, May 8). On May 7, 2020, the Centers for Medicare and Medicaid Services (CMS) released its final 2021 Notice of Benefit and Payment Parameters rule. LinkedIn. Retrieved online at https://www.linkedin.com/pulse/may-7-2020-centers-medicare-medicaid-services-cms-released-bill-remak/.
• Schmid, Carl (2020, May 7). Trump Administration Shocks Patients By Allowing Insurers to Increase Cost of Prescription Drugs. HIV+Hepatitis Policy Institute.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.