Accumulator Program Update: Washington Tells Insurers “Not So Fast”
Last fall we reported on a growing trend of insurance companies refusing to count third-party co-pay assistance payments against the insured’s annual out-of-pocket maximum. These programs, which essentially amount to “double-dipping” by the insurers, have the potential to dramatically increase the cost of medications for people with hemophilia and other high-cost conditions.
The hemophilia community, with the National Hemophilia Foundation (NHF) taking the lead, has been working to eliminate or minimize the impact of these programs. On April 18, 2019, these efforts bore fruit as the Centers for Medicare and Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters Rule for 2020. This rule, released annually, sets limits on what private insurance plans may or may not do. Although the new rule does not ban accumulator programs completely, it does limit their application to brand-name drugs that have equally effective generic alternatives. Because there are no generic drugs for hemophilia, all of the currently available drugs used to treat it should be exempt.
This is a very important win for the entire hemophilia community. However, it is likely that insurers will continue to look for other ways to limit what they pay while forcing patients to pay more. That’s why it is vital for us to consistently track any challenges community members face in getting their treatments covered. If you or someone you know encounter such challenges, please inform us at the Coalition for Hemophilia B, as well as the folks at your local chapter and other national organizations. You can always find more information at this “B Voice” section of our website: https://www.hemob.org/advocacy