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Consumers for Quality Care and Partners Voice Concerns Over the Proposed Notice of Benefit and Payment Parameters (NBPP) for 2021

WASHINGTON  – In a comment letter to the Centers of Medicare and Medicaid Services (CMS), Consumers for Quality Care (CQC) and seven of its partners  expressed concerns about provisions in the Proposed Notice of Benefit and Payment Parameters (NBPP) for 2021. If enacted, these changes could unfairly cut insurance coverage and raise out-of-pocket costs for prescription drugs for many Americans.

Signers of the letter include: Allergy and Asthma Network, American Kidney Fund, Consumer Action, First Focus on Children, Hydrocephalus Association, MANA: A National Latina Organization and Treatment Communities of America.

Together, the  eight organizations urge CMS to reject the proposal under consideration that would cancel automatic re-enrollment for enrollees whose premiums are fully covered by premium tax credits. They also oppose a provision that would prevent consumers from being able to get the most benefit possible from using drug manufacturer coupons to reduce their overall health care costs -- no matter what types of medicines they take -- without being penalized or shifting higher costs elsewhere.

Below is the full text of their comment letter.


March 2, 2020

Seema Verma
Administrator Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W., Room 445-G
Washington, D.C. 20201


Dear Administrator Verma, 

Thank you for the opportunity to comment on the Proposed Notice of Benefit and Payment Parameters for 2021. As a coalition of health care advocates who are committed to speaking up for ordinary Americans experiencing the health care system, Consumers for Quality Care (CQC) is concerned that this proposal will unfairly cut coverage and raise out-of-pocket costs for many.

While there are certainly positive aspects of this proposal, we are particularly worried that the proposed rule will do harm to consumers in the following areas: 

  • Automatic re-enrollment: 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. Because auto re-enrollment is the norm in the insurance industry, removing auto re-enrollment for certain people on the exchange will lead to consumers being unwittingly kicked off their plans. It will also add another unnecessary and burdensome requirement for them to maintain coverage during open enrollment when they should be able to depend on the coverage they previously selected and don’t intend to change.

We strongly oppose these changes you have proposed to cancel automatic re-enrollment for enrollees whose premiums are fully covered by premium tax credits (APTCs). Individuals who qualify for high enough APTCs to fully pay for their insurance premiums among the lowest income. They depend on the coverage they receive with the help of APTCs and preventing them from auto re-enrollment will reduce coverage among this group overall, likely without their knowledge, and lead to additional problems gaining and paying for access to care.    

  • Cost sharing for prescription drugs: This proposal also re-opens an issue that was previously considered and settled in the 2020 NBPP. The 2021 NBPP once again proposes increasing drug costs for consumers instead of relieving them from paying high prices for the prescriptions they need. 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 limit. These changes are problematic for consumers who are prescribed and rely on brand-name drugs, in particular, to treat chronic diseases, including Hepatitis C and HIV.

Coupons can also help with patient adherence to necessary medications. Some patients need access to branded medications when a generic substitution is not medically appropriate to treat them. Furthermore, patients who take prescription drugs that do not have a generic equivalent could be negatively impacted because they have no option to switch to a generic alternative.

All consumers should be able to get the most benefit possible from using coupons to reduce their overall costs -- no matter what types of medicines they take -- without being penalized or shifting higher costs elsewhere. We urge you to interpret the definition of cost sharing to include expenditures covered by drug manufacturer coupons.

The items in this proposed rule that we support and encourage include:

  • Value-based care: It is encouraging that CMS is proposing options for health plans to implement and encourage value-based insurance design. This is a step in the right direction to ensure that consumers are receiving patient-centered care that prioritizes quality while reducing overall costs. We do, however, urge CMS to ensure that efforts in this area do not impede access or raise costs for people with serious health conditions. Appropriate considerations must be taken into account for patients with complex and chronic conditions so that value-based insurance design avoids discriminatory plan design and selection.

  • Transparency in terminations: We support the provision to provide new notice requirements in terminations of exchange coverage or enrollment. It is important for consumers to be appropriately contacted when their coverage or enrollment is terminated.

  • Special enrollment coverage: CQC is fundamentally about making sure that more people are enrolled in quality, affordable health care coverage. Therefore, we support the proposal for new rules to shorten the time between the date a consumer enrolls in a plan through certain special enrollment periods and the effective date of that plan.

  • Metal level flexibility: We also agree with the new proposed flexibility to allow exchange enrollees and their dependents who are enrolled in silver plans and become newly ineligible for cost sharing reductions to change to a qualified health plan that is one metal level higher or lower, if they choose.

If you have any questions, please don’t hesitate to contact us.

Thank you,

Consumers for Quality Care

Allergy and Asthma Network

American Kidney Fund

Consumer Action

First Focus on Children

Hydrocephalus Association

MANA: A National Latina Organization

Treatment Communities of America

CQC is a coalition of advocates and former policy makers working to partner with health advocacy organizations and provide a voice for patients in the health care debate as they demand better care.

 

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