Health Plan Rule Change Could Increase Patient Costs

May 8, 2020

Washington, D.C.—The Department of Health and Human Services (HHS) this week finalized the 2021 Notice of Benefit and Payment Parameters, which sets the rules for health care plans in the coming year. Included in the rule is a provision that would allow health plans to choose to exclude the portion of patient drug costs paid for with co-pay assistance programs from out-of-pocket calculations, potentially increasing the amount patients are left to cover on their own. These coupons are often essential to patients’ ability to afford their medications. This policy will apply even if there is no generic alternative for the patient to take.

The administration decided against changes to automatic re-enrollment for a select segment of people who qualify for zero-premium plans through the health exchange.

A statement from the American Cancer Society Cancer Action Network (ACS CAN) follows:

“Allowing health plans to choose to ignore co-pay coupons in calculating a person’s total out-of-pocket drug costs could potentially result in millions of patients paying more for their prescriptions or being unable to get the drugs they need.

“For cancer patients, this could be especially damaging as the disease is complex and often requires specific medications for which there are few if any alternatives. Additionally, cancer patients frequently suffer from other treatment-associated conditions, compounding their need for particular medications and limiting possible alternative options.

“Shifting the costs otherwise covered by co-pay coupons onto the patient unfairly punishes them for something they are unable to control and may now be unable to afford.

“While we are disappointed with this particular rule change and its effects on patient costs, we are pleased to see the administration decided against another proposed change that would have made it much more difficult for certain low-income people to automatically re-enroll in health coverage through the health exchange. Making it as easy as possible to obtain and keep health coverage is essential to improving our nation’s health.”

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