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Late yesterday, the U.S. Department of Health and Human Services finalized a rule that affects individuals who rely on patient copay assistance programs. The HHS rule (the “2021 Notice of Benefits and Payment Parameters,” or NBPP) allows health insurers to continue using accumulator adjusters. This means that a health insurer can exclude manufacturer copay assistance amounts when calculating a patient’s overall deductible or out-of-pocket maximum. The upshot, for those whose health plans include an accumulator: much higher out-of-pocket costs and a serious barrier to access to care.

In comments submitted to HHS earlier this year, HFA and many other patient advocates stressed that manufacturer copay assistance programs serve as a critical lifeline for many people who live with chronic health conditions. Just days ago, HFA and other members of the All Copays Count Coalition wrote again to HHS Secretary Azar, warning that copay accumulators present especially serious threats to access to care amid the ongoing COVID19 crisis. Unfortunately, HHS disregarded this input when it chose to finalize the NBPP’s accumulator adjuster provisions.

HFA and allied groups will continue to advocate for federal and state policies that prioritize patient access to their prescription medications.

 


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