At a time when Americans are rightfully concerned about their ability to afford prescription drugs, it’s imperative that the health care system ease the burden on patients who require life-saving medications. The harsh reality is that many people are in need of assistance and are especially vulnerable during the COVID-19 pandemic, when so many individuals and families are struggling financially.
I know President Joe Biden is devoted to easing Americans’ financial burdens and making health care work. With the stroke of a pen, his health department can make prescription drugs more affordable for patients, particularly at a time of increased deductibles and cost-sharing being charged by insurers.
Currently pending at the U.S. Department of Health and Human Services is a regulation, the Notice of Benefit and Payment Parameters, that governs how every private insurance plan must operate. Within that regulation, the Biden administration can require insurers to count the copay assistance patients receive to afford their drugs towards their deductible and out-of-pocket requirements. In recent years, however, in an effort to extract more money from patients and double-bill the system, insurers have included new policies that don’t count copay assistance toward patient deductibles and out-of-pocket spending.
To lower the cost people pay for their prescription drugs right now and in the future, it’s imperative that Biden end this cruel practice being carried out by the insurance industry and its pharmacy benefit managers.
Research shows that the number of high-deductible health plans is increasing. According to the Kaiser Family Foundation, average deductibles for covered workers increased by 212 percent from 2008 to 2018. Due to these rising costs, patients often turn to copay assistance to not only afford their prescriptions but also to ensure that they are adhering to their medications.
According to IQVIA, high deductibles and high cost-sharing are the top reasons why patients abandon their medications, and having copay assistance significantly reduces their likelihood of prescription abandonment.
The health care system is doing an injustice to people living with chronic conditions when it’s designed in a way that requires patients to pay more, and, in some cases, make the difficult choice to abandon their required medications entirely. The smallest price increases have been shown to reduce adherence.
Even more disturbing is how preventable this could be: Often, the conditions for patients who abandon their prescriptions are otherwise treatable. In other situations, patients may decide to pay for their prescription drugs despite their higher out-of-pocket costs, but this may mean that they’re forgoing or cutting back on other preventative procedures or physician visits.
In one of the wealthiest nations in the world, patients should never have to make the false choice between reducing preventative care — such as physician visits — or paying for their prescription drugs.
Many Americans who struggle with chronic diseases simply cannot afford high deductibles and high coinsurance. Next year, the out-of-pocket maximum for individual patients will be $9,100 – an increase of 6.4 percent over 2021. This is in addition to their monthly premiums. That means that a patient could ending up paying $9,100 for their medication early in the year. This onus on patients – through no fault of their own – runs contrary to Biden’s commitment to advance health equity, minimize health disparities and create a more just health care system.
The Biden administration has recently proposed making premiums more affordable and opened a special enrollment period to sign up for health care, demonstrating the administration’s commitment to health care access in the middle of a pandemic.
The administration can further display this commitment to health equity by requiring insurers count copay assistance toward the deductible so patients can more easily access their needed medication and make health insurance work as it is intended to do. In doing so, Biden would ensure that health care, particularly prescription drugs, remains within reach for more Americans.
Carl Schmid is executive director of HIV+Hepatitis Policy Institute, which promotes quality and affordable health care for people living with or at risk of HIV, hepatitis or other serious and chronic health conditions.
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