Urge HHS to Reverse New NBPP Increasing Out-of-Pocket Drug Costs

Dear Health Advocate:

On May 14, 2020, HHS Secretary Alex Azar issued new regulations that will increase prescription drug costs for many patients with chronic illnesses, including HIV, viral hepatitis, and STIs. Patients with chronic health conditions are the most vulnerable among us and are often required to take specialty brand named drugs to treat their conditions as generics are not available. Many patients have been using drug manufacturer coupons to make these drugs more affordable at the pharmacy counter by reducing out-of-pocket costs. Now, the Trump Administration wants to take away the option of these coupons counting toward a patient’s out-of-pocket costs and deductibles.

The Centers for Medicare & Medicaid Services (CMS) 2021 Notice of Benefit and Payment Parameters (NBPP) will allow health insurers to exclude or disallow drug manufacturer coupons from annual cost-sharing totals, effectively increasing out-of-pocket costs and deductibles.

This rule was finalized despite the protests of health care access and patient advocacy groups.

  • In 2018, U.S. out-of-pocket prescription drug costs were $61 billion, with 19% of commercially insured patients using coupons to reduce the cost of brand name drugs; the value of these coupons summed to $13 billion, according to research from the IQVIA Institute. 

  • In 2019, HHS issued guidance requiring health plans to include the dollar value of drug coupons in members’ annual out-of-pocket cost-sharing burden—valuable for patients who need specialty brand name drugs for which there is no generic. This rule was not enforced, however.

The new HHS guidance states that insurance plans are permitted, but not required, to credit the dollar value of drug coupons to the patient’s annual cost-sharing amount, such as co-pays and deductibles. 

The National Coalition has advocated for keeping in place the Notice of Benefit & Payment Parameter provision finalized in May 2019 so that patients can access their prescription medications without undue financial burden and with lower out-of-pocket costs. This rule severely impacts people with chronic illnesses by allowing insurers to shift prescription drug costs to patients.

Please support the National Coalition for LGBT Health’s Co-pays Count Campaign by contacting HHS Secretary Azar (Alex.Azar@HHS.GOV, 202-690-7000) and urging HHS to reconsider the proposed provision in the 2021 Notice of Benefit Payment Parameters that grants issuers the discretion not to count drug copayment assistance towards a member’s annual cost sharing, regardless of whether a generic exists.

Please contact Michael D. Shankle, MPH, Senior Director of Advocacy, at michael@healthLGBT.org or 202.507.4730 with any questions or comments.