U.S. Sen. Thom Tillis (R-NC) recently joined a bipartisan contingent of lawmakers in urging the Biden administration to ensure that patients receive cost-sharing protections for their prescription drugs.
The senators requested that the U.S. Department of Health and Human Services (HHS), the U.S. Department of Labor (DOL), and the U.S. Treasury Department lower out-of-pocket costs for prescription drugs by enforcing a rule limiting the use of “copay accumulators,” which prevent copay assistance from counting toward a patient’s deductible or out-of-pocket maximum.
Doing so would allow more patients to be able to afford their medications, according to a Dec. 20 letter that Sen. Tillis and 18 of his colleagues sent to HHS Secretary Xavier Becerra, Treasury Secretary Janet Yellen, and DOL Acting Secretary Julie Su.
The senators noted their disappointment with an HHS notice of appeal of the decision from the U.S. District Court for the District of Columbia that vacated the 2021 Notice of Benefit and Payment Parameters (NBPP) Final Rule provision permitting the use of copay accumulator adjustment programs.
“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,” they wrote. “Instead of appealing the court’s ruling, we urge you to adopt policies from the 2020 NBPP that strike the right balance of preserving a plan’s ability to control costs while also putting the patient first.”
Among the lawmakers who joined Sen. Tillis in signing the bipartisan letter were U.S. Sens. Joni Ernst (R-IA), Shelley Moore Capito (R-WV), Mike Rounds (R-SD), Susan Collins (R-ME), and Tim Kaine (D-VA).
In their letter, the senators also pushed for the bipartisan, bicameral Help Ensure Lower Patient (HELP) Copays Act, S. 1375/H.R. 830, which would permanently prohibit the use of copay accumulators and require health plans and Pharmacy Benefit Managers to count the value of copay assistance toward a patient’s deductible or out-of-pocket maximum.
“As you consider next steps, we strongly encourage you to support patients by reconsidering your appeal of the court’s ruling and instead adopting the 2020 NBPP policy,” wrote the senators. “It required plans to count manufacturer copay assistance toward the annual limitation on cost-sharing for drugs that do not have a medically appropriate generic equivalent available.”
Sen. Tillis and his colleagues “strongly believe” that such federal legislative action is needed to restore these vital patient protections, according to their letter, which has garnered support from the Arthritis Foundation, the National MS Society, and the Cancer Support Community.