Autoimmune Association Statement on CMS Decision to Delay Copay Assistance Rule

Washington, D.C. (Tuesday, December 22, 2020) — Autoimmune patients welcome the Administration’s decision to delay implementation of the Medicaid best price rule that would jeopardize critically important copay assistance programs. The two-year delay highlights the flawed nature of this harmful policy. While the action is a step in the right direction, Autoimmune Association remains deeply concerned that the proposed change could eventually be implemented.  Instead, this provision should be withdrawn.

In a survey earlier this year, Autoimmune Association found that 92 percent or more of autoimmune patients report that copay assistance helps them afford medicines and take them as prescribed. Reducing copay assistance programs potentially threatens patient health and well-being by unfairly shifting the burden of cost away from insurers and PBMs and onto patients, who are often struggling to manage costs of care.

Earlier this year, Autoimmune Association strongly opposed an equally harmful policy that will permit insurers and PBMs to exclude the value of copay program cost-sharing assistance when calculating a patient’s deductibles and out-of-pocket maximum requirements. Unlike the rule that was just delayed, this rule governing insurance practices could affect patients in the New Year, and a follow-along proposed rulemaking for 2022 further calls into question support for copay assistance support to patients longer-term. Collectively, the Administration’s delayed rule, and those slated for immediate implementation by insurers and in 2022, represent a threat to the ability of patients to access their medicines and take them as prescribed, even as they and their families struggle with negative implications of the COVID-19 pandemic.

Autoimmune Association continues to advocate for patients’ access to care, and we urge policymakers and regulators do the same. Patients deserve better. Autoimmune Association strongly encourages the new Administration and the new Congress to support copay assistance and put patients’ health and wellness first.

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Contact: Brett McReynolds; 615-594-0145; [email protected]