Infectious Disease

ACR urges CMS to revise policy excluding copay assistance from counting toward deductible

February 14, 2023

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The American College of Rheumatology is urging CMS to reconsider its current policy of allowing insurers to exclude copay assistance programs from counting toward a patient’s deductible, according to a press release.

In a submitted comment to CMS Administrator Chiquita Brooks-LaSure, ACR President Douglas White, MD, PhD, stated that patients with rheumatic diseases often rely on higher-priced therapies, such as biologics, to manage their disease and improve their quality of life. He argued that copay assistance programs enable patient access to these necessary treatments.

Hospital hall

The ACR has submitted comments to CMS asking the organization to reconsider policies relating to copay assistance programs prior to the adoption of the 2024 rules, according to a press release. Source: Adobe Stock

“To allow our patients to access these treatments, many rely on manufacturer copay assistance to help defray the high costs associated with their medically necessary treatments,” wrote White in the letter, dated Jan. 25. “According to a 2016 study by the USC Schaeffer Center for Health Policy and Economics, 20% of brand-name prescriptions use copay coupons to help defray the cost of treatment.”

According to the ACR, the HHS Notice of Benefit and Payment Parameters proposed rule for 2024 fails to revise the current policies allowing insurers to exclude copay assistance from counting toward a patient’s deductible. The ACR is calling on CMS to change the policies regarding copay assistance programs prior to the adoption of the 2024 rules.

Without copay assistance, many patients will be unable to pay their deductible, resulting in delays to needed treatment, medication rationing or forfeiting treatment entirely, the ACR said in the release.

“The ACR is deeply concerned that the proposed policies to increase the maximum out-of-pocket limitations, coupled with allowing insurers to exclude copay coupons to be applied toward a patient’s out-of-pocket limit, debilitates our patients’ ability to access the treatments needed to help manage their painful chronic conditions,” White wrote in the letter. “While we understand the need to find solutions to help curb the increasing cost of health care, we cannot support policies that sacrifice our patients’ health in the name of cost savings.”

Read the ACR’s full letter to CMS here.

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