ACR urges CMS to revise the policy to exclude co-pay assistance from deductible

January 31, 2023

One minute read

We were unable to process your request. Please try again later. If this issue continues to occur, please contact

The American College of Rheumatology is urging CMS to reconsider its current policy of allowing insurers to exclude joint assistance programs from relying on a patient discount, according to a news release.

In a comment sent to the CMS administrator Chiquita Brooks-no thanksAnd Head of the ACR Douglas White, MD, PhDAnd He mentioned that patients with rheumatic diseases often depend on expensive therapies, such as biological medicines, to manage their disease and improve their quality of life. argue that Co-pay assistance programs Enabling the patient to access these necessary treatments.

ACR provided comments to CMS asking the organization to reconsider policies regarding participation assistance programs before adopting the 2024 rules, according to a press release. Source: Adobe Stock

“To allow our patients access to these therapies, many rely on the manufacturer’s assistance to co-pay the high costs associated with their medically necessary treatments,” White wrote in the letter dated Jan. 25. Schaeffer Center for Health Policy and Economics, 20% of brand-name prescriptions use copay coupons to help defray the cost of treatment.”

According to the ACR, HHS’ proposed 2024 Benefits and Payment Notice rule fails to revise existing policies that allow insurers to exclude co-payment assistance from relying on a patient deductible. ACR CMS is calling for a change in policies around participation assistance programs before the 2024 rules are adopted.

without Co-pay assistanceThe Authority for Academic Accreditation said in the statement that many patients will not be able to pay the deducted amounts, which leads to delays in required treatment, rationalization of medications, or loss of treatment entirely.

“ACR is deeply concerned that the proposed policies to increase Maximum pocket restrictionsCombined with allowing insurance companies to exclude co-pay vouchers to be applied at the patient’s out-of-pocket limit, it impairs our patients’ ability to access therapies needed to help manage their painful chronic conditions,” White wrote in the letter.. “While we understand the need for solutions to help reduce the growing cost of health care, we cannot support policies that sacrifice our patients’ health in the name of cost savings.”

Read ACR’s full letter to CMS here.

Leave a Comment