New rule makes it harder for patients to lower their out-of-pocket costs

Pharmaceutical Research and Manufacturers of America

20 May 2020 - In the midst of increased financial insecurity for Americans due to the COVID-19 pandemic, it is shocking the Administration finalised a policy change in the 2021 Notice of Benefit and Payment Parameters allowing insurers and pharmacy benefit managers to make it harder for patients to have manufacturer cost-sharing assistance count towards their out-of-pocket caps for medicines.

The Department of Health and Human Services’ (HHS) reversal of its own decision – made just last year –to require health plans to count cost-sharing assistance toward out-of-pocket caps is at odds with the Administration’s goal of improving patient affordability.

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Michael Wonder

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Michael Wonder