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Recent Moves Could Make Health Care Less Affordable
Guest Opinion 8-19-20
health care

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

Yet, in the midst of an unprecedented public health crisis, the Administration finalized a rule that could make the lives of Americans 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 out-of-pocket spending. This could cause pharmacy costs to skyrocket – and make it difficult to fill prescriptions or take medicines as prescribed.

High pharmacy costs have burdened those on multiple medications. Roughly half of Americans report difficulties affording medicines.

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

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

That’s why coupons offered by drug manufacturers are more important than ever.

Roughly one in five privately insured patients who relies on a branded drug uses a coupon to keep out-of-pocket costs down. Traditionally, coupons save hundreds of dollars 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 a charge of $50.

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

Under the CMS rule, insurers can pretend the coupons were intended for their benefit. This will increase the money patients must spend before insurance benefits kick in.

As someone who spent his 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 worsen health outcomes for millions.

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

As out-of-pocket costs rise, “non-adherence” will rise. That’s a big reason why states require insurers to count the full value of copay coupons.

Unfortunately, this isn’t the Administration’s only effort to hurt patients. The president is supporting states seeking to invalidate the Affordable Care Act in the Supreme Court. If they succeed, millions of Americans could lose coverage.

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

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

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


Patrick J. Kennedy is a mental health advocate and former Rhode Island congressman. . The opinions expressed are those of the author and not necessarily those of this paper or its corporate ownership.