Stripping Patients of Vital Cost-Sharing Assistance Plans
June 30, 2020
June 30, 2020
Cambridge Chronicle & Tab
By Richard Pezzillo/Guest Columnist
June 25, 2020
With the third-highest number of deaths from COVID-19 in the nation, it’s no secret that Massachusetts has suffered greatly from the pandemic. Fortunately, with public health guidance, the state has begun to reopen the economy in phases and Massachusetts’s schools are planning for the fall semester. It seems like, finally, there may be some good news ahead for the commonwealth. Unfortunately, there are other challenges that face patients.
While we may have outlasted the initial trauma of the novel coronavirus, several lingering concerns present serious risks to public health. Chief among them: the impact of government policy on the lives of Massachusetts residents.
Considering the ongoing crisis, one may have expected the national government to institute policies designed to help vulnerable Americans struggling under the coronavirus pandemic threat. But a recent change by the administration included in the 2021 Notice of Benefit and Payment Parameters (NBPP) suggests otherwise.
The latest NBPP finalized rule reverses patient protections that were included in the 2020 rule. Now insurers will be allowed to implement insurance schemes called accumulator adjustment programs. Under these programs insurers will not count copay assistance toward a patient’s out-of-pocket maximum. These programs strip patients of vital cost-sharing assistance plans, robbing them of the means to afford their medication.
It’s a change that effectively permits insurance companies to increase the price of medication for patients at the pharmacy counter. And particularly during the coronavirus pandemic, the sudden policy reversal is as devastating as it is inexcusable. Clearly, the regulatory change will increase patient prescription drug expenses, causing people to spend more out-of-pocket money on health care. But more than that, the final rule will target those already at an increased risk of coronavirus complications—people with chronic health conditions.
Take, for instance, patients with hemophilia — the individuals our organization was created to protect over six decades ago. For treatment, these individuals must receive regular doses of medication as prophylaxis against uncontrolled bleeding. On average, the cost of this annual treatment can total an astounding $250,000 per patient, as sadly, there is no generic medicinal substitute. To afford this medication, many patients rely upon cost-assistance programs, which help them financially to reach their maximum deductible without breaking the bank.
If insurance companies are allowed to begin transitioning toward accumulator adjustment programs, that cost-sharing assistance could disappear. Already struggling under the COVID-19 lockdown measures and potentially out of a job, patients will be forced to endure further financial hardship — the unaffordability of their life-preserving treatments. Needless to say, the result will be catastrophic.
Whether patients are skipping doses to make ends meet or abandoning their treatment entirely, the outcome will be the same: dramatically worse health care outcomes, which could lead to death. Indeed, accumulator adjustment programs, and the federal regulatory policy that encourages their proliferation, are clearly a major step in the wrong direction. Now, more than ever, people need affordable health care, and it is incumbent upon our insurers to provide it without the added obstacles that these programs will create.
Richard Pezzillo is executive director of the New England Hemophilia Association.