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As I See It: Administration responds to pandemic by making health care less affordable

Telegram & Gazette
Jun 03, 2020

COVID-19 has exacerbated the struggles faced by Americans living with mental health conditions like depression, anxiety and bipolar disorder.

Yet shockingly, in the midst of an unprecedented public health crisis, the administration just finalized a rule that could make the lives of these Americans much more challenging.

The new rule from the Centers for Medicare and Medicaid Services allows insurers to ignore the value of copay assistance coupons when calculating patient out-of-pocket spending. This could cause pharmacy costs to skyrocket for many of the most vulnerable Americans -- and thus make it difficult for people to fill their prescriptions or take their medicines as prescribed.

High pharmacy costs have long burdened those who rely on multiple medications to stay healthy. Roughly half of Americans in poor or fair health report difficulties affording their medicines.

The outbreak of COVID-19 has worsened this financial strain. Since lockdowns began taking effect, tens of millions of Americans have lost their jobs. People everywhere are struggling to make ends meet.

At this time of prolonged uncertainty, stress and isolation, the risks faced by mental health patients are particularly severe. Tens of millions of Americans suffer from some form of mental illness. Among them, roughly 40 million depend on antidepressant, anti-anxiety, or antipsychotic medications.

That's precisely why the coupons offered by drug manufacturers are now more important than ever.

Right now, roughly one in five privately insured patients who relies on a branded drug uses a coupon to keep her out-of-pocket costs down. Traditionally, these coupons can save patients hundreds of dollars at the pharmacy counter each year.

Consider a 45-year-old female who relies on a brand-name antidepressant that carries a copay of $200 each month. The drug's manufacturer might offer a $150 coupon, leaving her with a monthly pharmacy charge of just $50.

Today, most insurers would count the full $200 as out-of-pocket spending, thus helping the patient quickly approach her prescription drug deductible. This is logical; a $150 copay assistance coupon should be treated just like a $150 gift card.

Under the new CMS rule, insurers can pretend as if the coupons were intended for their benefit. This will dramatically increase the amount of money that patients must spend before their full insurance benefits kick in.

As someone who has spent his entire career -- inside the House of Representatives and out -- working to strengthen mental health care, I am shocked by the recklessness of this rule. It gives insurers free reign to impede access to lifesaving medications, which could worsen health outcomes for millions in the middle of a pandemic.

When out-of-pocket spending rises, data demonstrates that patients veer from their necessary medications. About 30 percent of patients say they have failed to take their medicines as prescribed for financial reasons. Fifty percent of those with major depression or anxiety disorders already deviate from their treatment regimens. And a third of those prescribed antipsychotics and anxiolytics don't appropriately follow their medication regimens.

As out-of-pocket costs rise, this "non-adherence" will surely rise as well. That's a big reason why several states require insurers to count the full value of copay assistance coupons.

Unfortunately, this isn't the administration's only effort to hurt patients. The president is also supporting a group of states seeking to invalidate the Affordable Care Act in the Supreme Court. If they succeed, millions of Americans could lose their health coverage.

This is no way to respond to a pandemic. Our leaders should be prioritizing efforts that ensure patients can continue to access their medications at little cost. For instance, the House just passed the HEROES act, which includes a provision to subsidize COBRA coverage -- the program that allows laid-off workers to keep their employer-sponsored health insurance. Such legislation is exactly the sort of action we need right now.

The COVID-19 crisis has compounded the health and financial challenges so many Americans already face. And sadly, our Administration seems hellbent on aggravating those challenges.

Fortunately, insurers are under no obligation to take advantage of this new rule. By counting the coupons, insurers can show that they care about their customers' well-being and want to be part of a true recovery effort.

Patrick J. Kennedy is a mental health advocate and former Rhode Island congressman.

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