A new proposal from the Trump administration would unfairly cut insurance coverage and raise prescription drug costs for many.
Out-of-pocket costs for prescription drugs are a major concern for millions of Americans. President Trump has promised to make prescription drugs more affordable. However, a new proposed rule from the Centers for Medicare and Medicaid Services would have the opposite effect and could actually increase out-of-pocket prescription drug costs for Americans. Insurers would be able to bar drug manufacturer coupons that consumers often use to lower their drug costs at the pharmacy counter from counting toward their annual cost-sharing limits.
The same proposal would also cancel automatic insurance re-enrollment for some people who get their health care coverage through HealthCare.gov or a state exchange. Consumers whose insurance premiums are fully covered by tax credits would be kicked off their coverage at the end of every year and forced to re-enroll. Discontinuing coverage every year for consumers who previously selected coverage will lead to fewer people being covered and problems accessing care.
The 2021 Notice of Benefits and Payment Parameters proposal would:
Cancel automatic coverage re-enrollment for many consumers: Auto re-enrollment in coverage is common practice in the insurance industry at large. It provides continuity of coverage for people who have already selected the insurance coverage they want. This proposal will remove auto re-enrollment for people whose insurance premiums are fully covered by tax credits. It will lead to consumers being unwittingly kicked off their plans and add another unnecessary and burdensome requirement for them to maintain coverage during open enrollment.
Increase out-of-pocket costs for countless Americans overnight: The new proposed rule would increase out-of-pocket costs for many Americans overnight by encouraging insurers and pharmacy benefit managers to prevent coupons from applying to cost sharing maximums. Without the assistance of coupons, many Americans would simply be unable to afford their medications, leading many to make tough choices or simply stop taking the medications their doctors prescribe.
Make it harder for the millions of Americans with chronic conditions who rely on co-pay assistance to afford their medications: 133 million Americans, or 40% of the population, live with chronic diseases. For many of these patients, prescription drugs are often necessary for survival. Already, people with chronic conditions face significant barriers to getting the medicine they need, including having to get prior authorization for their prescription drugs and step therapy. Without the assistance of coupons, these problems would be compounded with untenable copay costs.
Override the wishes of states who have already banned this egregious practice: In West Virginia, Illinois, Arizona and Virginia, lawmakers realized the dangers of these programs and banned them. The federal government rule would override those bans and encourage insurers and pharmacy benefit managers to adopt the harmful programs.
This proposal is bad for consumers because it would cut coverage and raise out-of-pocket costs for millions of Americans. Consumers for Quality Care is fighting to prevent these changes and we need your help. Please take a moment to send a letter voicing your concerns.