The “Preserving Patient Savings on Drug Costs Act” (H.R. 7647) would delay for one year after the COVID-19 pandemic the rise of costs of prescription medications for millions of Americans via the Notice of Benefit and Payment Parameters (NBPP) rule recently issued by the Centers for Medicare & Medicaid Services (CMS).
The NBPP rule for 2021 allows certain health plans to determine, to the extent permitted by state law, whether to count pharmaceutical manufacturer assistance with enrollee cost-sharing toward the plan’s annual limit on cost-sharing. This policy applies to health plans sold on the Affordable Care Act (ACA) exchanges, as well as non-grandfathered individual and group health plans (including self-insured plans). States could impose different requirements for fully insured plans. This policy makes it easier for group plans and issuers to adopt “copay accumulator” programs which can cause an expensive out-of-pocket bill.
Many Americans, particularly those with chronic diseases, rely on medicines to manage their conditions. With copay accumulator programs, insurers no longer allow drug cost sharing coupons to count towards patients’ deductibles or caps on total out-of-pocket costs. For some patients, their coupons run out before the end of the year—leaving them with unexpected amounts they can’t afford to pay when they try to fill a prescription at the pharmacy. Now is not the time to raise costs for health care consumers.