North Charlotte Today

WASHINGTON, D.C. – Senator Thom Tillis and his colleagues have called on the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury to take action in reducing out-of-pocket costs for prescription drugs. The senators have sent a letter urging these departments to enforce a rule that limits the use of harmful "copay accumulators," which hinder patients' ability to afford their medications.

The senators have also introduced the Help Ensure Lower Patient (HELP) Copays Act, which aims to permanently prohibit the use of copay accumulators. The act would require health plans and Pharmacy Benefit Managers (PBMs) to count the value of copay assistance towards a patient's deductible or out-of-pocket maximum.

In the letter, the senators express their support for a recent decision by the U.S. District Court for the District of Columbia. The court vacated a provision that allowed the use of copay accumulator adjustment programs (AAPs) and remanded the decision to HHS to interpret the definition of "cost-sharing." The senators are disappointed in HHS's decision to appeal the court's ruling and not take any enforcement action against health insurance issuers or plans that fail to count copay assistance towards the patient's maximum annual limitation on cost-sharing.

The senators urge HHS to reconsider their appeal and instead adopt the 2020 NBPP policy. This policy required plans to count manufacturer copay assistance towards the annual limitation on cost-sharing for drugs without a medically appropriate generic equivalent. The senators argue that this approach would be less likely to disincentivize lower-cost alternatives and distort the market. They highlight situations where patients have faced significant out-of-pocket costs because copay accumulators did not apply the value of manufacturer-sponsored assistance to their deductible.

The senators also emphasize the need for federal legislative action to restore this vital patient protection. They mention ongoing bipartisan and bicameral efforts in Congress to advance legislation that ensures copay assistance counts towards the patient's maximum annual limitation on cost-sharing.

Several organizations have voiced their support for the senators' efforts. Anna Hyde, Vice President of Advocacy and Access for the Arthritis Foundation, emphasizes the importance of copay assistance for patients who rely on expensive biologic medicines with no generic alternatives. She states, "More patients than ever are reaching out to us because they've been negatively impacted by these programs."

Bari Talente, EVP, Advocacy & Healthcare Access at the National MS Society, expresses disappointment with the Biden Administration's decision to appeal the court's ruling and continue using copay accumulators. Talente highlights the impact on the 1 million Americans living with multiple sclerosis, stating that many are unable to afford life-changing medications.

The Cancer Support Community also opposes the use of copay accumulators. They have witnessed the adverse effects of these programs on patients' ability to access life-saving medications. The organization supports the adoption of the 2020 NBPP policy, which protects affordability and access to care for under-resourced patients who rely on manufacturer copay assistance programs.

In conclusion, the senators urge the departments to take action in lowering prescription drug costs and ensuring that copay assistance counts towards patients' out-of-pocket maximums. They emphasize the importance of supporting patients and addressing affordability and access challenges for medication. The full text of the letter can be found on the senators' website.

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For additional details, please follow this link: https://www.tillis.senate.gov/2024/1/tillis-colleagues-push-to-lower-prescription-drug-costs