The Importance of Copay Assistance Protections: Awareness Grows 

building facade

For over three decades, March has been designated “Bleeding Disorders Awareness Month.” HFA and member organizations across the country mark the occasion with monthlong education and advocacy activities – social media outreach, state and local proclamations and resolutions, Hill Days, and more. 

In March 2023, as in past years, HFA was pleased to take part in NHF’s Washington Days fly-in. A principal “ask” was for lawmakers to support H.R. 830, the HELP Copays Act, introduced by Reps. Carter and Barragan. This bipartisan legislation would prohibit copay accumulator adjusters – strategies used by health insurers to redirect the benefit of copay assistance from the patient and to the health insurer’s own bottom line. If enacted, H.R. 830 would require health plans to count the value of copay assistance toward patient cost-sharing requirements. It would also close a loophole in existing law that allows health plans to define entire categories of prescription drugs as “non-essential health benefits” – thereby allowing the plans to hike patient cost-sharing for those drugs far above statutory limits. 

It was heartening to hear, during visits to the various offices, that lawmakers are hearing about H.R. 830 from a variety of patient groups. (Copay accumulator adjusters affect people with a range of serious, complex and chronic health conditions, who are united in the effort to ensure that “all copays count.”) It is also encouraging to see the rising number of cosponsors for the bill: 27 cosponsors as of March 27th. Advocacy matters! If you couldn’t come to Washington in March, please consider emailing your lawmaker to support H.R. 830 via HFA’s easy-to-use Legislative Action Center. 

Quick Hits: 

  • North Carolina’s legislature has voted to expand the state’s Medicaid program to cover low-income adults in the state without regard to disability. Governor Roy Cooper signed the legislation on March 27, but implementation of Medicaid expansion still requires the Governor and North Carolina legislature to agree on a budget. Implementation would make North Carolina the 40th state to expand Medicaid and would provide health insurance to up to 600,000 people. Congratulations to the Bleeding Disorders Foundation of North Carolina and all the allied patient advocates who worked so hard for passage of this legislation! 
  • Cost-free preventive care is in jeopardy in the wake of a sweeping federal court decision invalidating a key provision of the Affordable Care Act. The March 30 ruling in Braidwood v. Becerra blocks enforcement of ACA provisions requiring health plans to cover a wide range of preventive care services with no patient cost-sharing. The ruling also finds that employers may decline to cover HIV prevention drugs on religious grounds. HFA and 15 other patient groups had previously filed a “friend of the court” brief in the litigation, urging the court to uphold the ACA requirement. The allied patient groups released a statement warning that the Braidwood decision endangers patient health. The Administration has already filed a notice of appeal in the case. 
  • Pending the governor’s expected signature, New Mexico will shortly become the 17th state to enact consumer protections against harmful copay accumulator adjusters (and the first in 2023).  Similar legislation has advanced in Missouri and the District of Columbia and remains active in several states including California, Oregon, Texas, and Wisconsin. 
  • Also on March 23rd, the Administration marked the 13th anniversary of the Affordable Care Act’s enactment. The U.S. Centers for Medicare & Medicaid Services (CMS) noted that, during 2023 open enrollment, a record high 16.4 million people signed up for Marketplace coverage (with 90% of those purchasers eligible for subsidies to help pay for premiums). In total, more than 40 million people are currently enrolled in Marketplace or Medicaid expansion coverage under the ACA – the highest ever.  
  • Five states (Arizona, Arkansas, Idaho, New Hampshire and South Dakota) told CMS that they plan to begin Medicaid coverage terminations as soon as possible in April, pursuant to the “unwinding” of a three-year, COVID-related pause on Medicaid disenrollments.  At least seven others (including California and New York) will wait until July while Oregon will not start terminations until October.  Meanwhile, CMS released guidance warning states that the agency will levy fines or stop disenrollments in states found to be violating federal safeguards around the Medicaid redetermination process. 
  • President Biden released his proposed FY 2024 budget on March 9, 2023. The President’s budget is just a starting point for negotiations with Congress, but it is still indicative of the Administration’s policy priorities. On the health front, the President has proposed (among other things): 
    • Permanently extending the enhanced tax credits that help people pay premiums for ACA health insurance, and providing some form of “Medicaid-like coverage” for people currently trapped in a coverage gap in Medicaid non-expansion states; 
    • Expanding access to paid family and medical leave, and requiring employers to offer at least seven sick days per year; 
    • Extending surprise medical billing protections to ground ambulance services; and Further expanding the drug pricing reforms contained in the 2022 Inflation Reduction Act, allowing Medicare to negotiate prices for more drugs and bringing drugs into negotiation sooner after they launch. 
  • House Republicans announced that they are launching an investigation into companies that manage drug benefits (PBMs) – and what role those companies play in increasing drug costs and limiting patient care. Rep. Comer, chair of the House Committee on Oversight and Accountability has sent inquiries to the nation’s largest PBMs as well as to CMS and other federal agencies.