WASHINGTON – U.S. Senator Chris Coons (D-Del.) joined Senators Tim Kaine (D-Va.), Roger Marshall (R-Kan.) and a bipartisan group of their colleagues in a letter urging the U.S. Department of Health and Human Services (HHS), the U.S. Department of Labor, and the U.S. Department of the Treasury to lower out-of-pocket costs for prescription drugs by enforcing a rule limiting the use of harmful “copay accumulators.” Copay accumulators prevent copay assistance from counting toward a patient’s deductible or out-of-pocket maximum, which makes it harder for patients to afford their medications.
Regarding a recent court ruling limiting the use of copay accumulators, the Senators wrote, “This decision is an important step in the right direction for low-income and other eligible patients who rely on manufacturer and nonprofit copay assistance programs to alleviate affordability and access challenges for their medicines.”
The lawmakers continued, “Instead of appealing the court’s ruling, we urge you to adopt policies from the 2020 NBPP [Notice of Benefit and Payment Parameters] that strike the right balance of preserving a plan’s ability to control costs while also putting the patient first.”
In the letter, the Senators also push for the Help Ensure Lower Patient (HELP) Copays Act to permanently prohibit the use of copay accumulators and require health plans and Pharmacy Benefit Managers (PBMs) to count the value of copay assistance toward a patient’s deductible or out-of-pocket maximum.
In addition to Senators Coons, Kaine, and Marshall, the letter is signed by Senators Joni Ernst (R-Iowa), Ed Markey (D-Mass.), Lisa Murkowski (R-Alaska), Elizabeth Warren (D-Mass.), Ted Budd (R-N.C.), Kirsten Gillibrand (D-N.Y.), Shelley Moore Capito (R-W.Va.), Cory Booker (D-N.J.), Thom Tillis (R-N.C.), Mike Rounds (R-S.D.), Chris Van Hollen (D-Md.), John Boozman (R-Ark.), Jeanne Shaheen (D-N.H.), Susan Collins (R-Maine), Mazie Hirono (D-Hawaii), and Kyrsten Sinema (I-Ariz.).
“More patients than ever are reaching out to us because they’ve been negatively impacted by these programs,” said Anna Hyde, Vice President of Advocacy and Access, the Arthritis Foundation. “They are being caught in a financial bind because they can’t pay the full cost of their medications. Biologic medicines are expensive and there are no generic alternatives, so copay assistance is often a vital lifeline for them.”
“Far too many of the 1 million Americans living with multiple sclerosis are unable to afford life-changing medications to reduce the number of relapses, delay the progression of disability, and limit new disease activity. The National Multiple Sclerosis Society is disappointed with the Biden administration’s decision to appeal the court’s September 29 ruling and continue the use of copay accumulators that will negatively impact access to care. We urge the withdrawal of their recently filed appeal,” said Bari Talente, Executive Vice President, Advocacy and Healthcare Access, the National Multiple Sclerosis Society.
“Too many rare-disease patients struggle to afford the therapies they need. Copay accumulator programs hurt the most vulnerable rare disease patients who rely on manufacturer copay assistance to afford their medications by dramatically increasing their cost-sharing liability. NORD supports the district court’s decision to vacate portions of the 2021 NBPP final rule that permitted the use of copay accumulator programs, and we are grateful for the strong bipartisan and bicameral support for the HELP Copays Act, which would cement this decision legislatively. NORD is grateful to Senator Marshall and Senator Kaine for spearheading this letter to HHS on this important issue and for their continued leadership in protecting rare disease patients,” said Peter Saltonstall, President and CEO, National Organization for Rare Disorders (NORD).
“The NPF Patient Navigation Center is constantly fielding calls from people who can’t afford the medicine they have been prescribed because of copay accumulator practices, so we are clearly disappointed in the administration’s move to appeal the decision of the U.S. District Court for the District of Columbia that would limit their use,” said Leah M. Howard, President and CEO, the National Psoriasis Foundation. “We join Senators Doc Marshall and Tim Kaine in urging the administration to renew policies ensuring copay assistance is counted toward deductibles and out-of-pocket maximums.”
“The Biden administration has made it a priority to make healthcare more accessible and affordable for Americans. HHS can do just that – make necessary and lifesaving treatments more accessible and affordable for the most vulnerable Americans, those with rare and serious, chronic illnesses. Senators Marshall and Kaine have led the way in Congress by centering patients in the discussion on healthcare access. We encourage HHS to follow suit, align with the administration’s priorities, and enforce the 2020 NBPP. Now is the time to do right by patients!” said the AIDS Institute.
“While serving a million people impacted by cancer each year, we at the Cancer Support Community (CSC) have witnessed the adverse effects of copay accumulator adjustment programs (AAPs) on patients’ ability to access lifesaving medications. CSC strongly opposes the use of AAPs and supports the adoption of the 2020 NBPP policy, protecting affordability and access to care for under-resourced patients who rely on manufacturer copay assistance programs. We are grateful to have leaders that share our commitment to breaking down barriers and improving healthcare for all,” said the Cancer Support Community.
The full text of the letter is available here.