For many of the thousands of Wyomingites dealing with mental health issues, prescription medications are essential in helping them control the symptoms of their disease and live a normal life. The National Alliance on Mental Illness (NAMI) Wyoming opposes a change in federal policy on copay assistance that could make those life-altering medications more expensive.
It’s estimated that roughly 5,000 men and women in Wyoming suffer from schizophrenia and 10,000 are living with bipolar disorder, both mental health conditions that can be treated with prescription medications. Taken on an ongoing basis, those drugs can be expensive, especially for lower-income people or seniors living on a fixed retirement income.
Drug manufacturers frequently offer copay assistance that helps reduce the out-of-pocket cost patients must pay at the pharmacy when they pick up their prescriptions. This assistance is especially valuable when it helps pay down the total amount a patient is responsible for each year, their annual out-of-pocket maximum.
But now, the U.S. Department of Health and Human Services (HHS) has reversed copay assistance protections previously included in the 2020 Notice of Benefits and Payment Parameters (NBPP). Beginning in 2021, insurance companies would be given the option not to count copay assistance towards a patient’s out-of-pocket limit. With the green light to shift more costs onto patients, it’s likely that many insurers and PBMs will seize the chance to stop counting manufacturer assistance, giving them a short-term profit increase.
The ability to limit the value of copay assistance to patients is an insurance benefit design called accumulator adjustment programs. By making it more difficult for patients to reach their out-of-pocket spending maximum, insurers can use this tactic to more or less get paid twice, once when they receive the value of the manufacturer assistance and then again when the patient is forced to pay the full price of a brand-name medication. It’s essentially government-sanctioned double-dipping for insurance companies.
Intentionally increasing the cost of daily medications could have serious impacts on the many people in Wyoming who depend on those drugs to stabilize their mental illness. Studies have directly linked higher out-of-pocket costs to reduced adherence to drug regimens, making it more likely that patients who cannot afford to follow their doctor’s recommendations will see their symptoms reappear or worsen. That may mean more trips to clinics, emergency rooms and hospitals, expensive outcomes that not only hurt patients but also increase costs for insurers, potentially wiping out the savings they realized by adopting the accumulator adjustment programs.
Ultimately, this change is anti-patient and quite frankly, it could not come at a worse time. Our nation is still in the midst of a global pandemic and patients should not have to face additional financial barriers to receive the care they need. Congress should delay the policy change in the 2021 NBPP final rule until after this public health emergency has passed. A delay will allow time for policymakers to fully evaluate the consequences of the change and ensure that patient harm is minimized moving forward. Please join NAMI Wyoming in speaking out against accumulator adjustment programs.
Amanda Jones is the executive director of National Alliance of Mental Illness (NAMI) Wyoming.