Will the Biden Administration Tackle Co-Pay Card Reform?

April 6, 2021

The Biden administration’s ambitious plan to protect patients is off to a promising start.  

In February, President Biden called for the reopening of the federal insurance marketplace for a special enrollment period. Reopening the marketplace provided the millions of people who lost their employer-sponsored coverage the opportunity to enroll in a plan of their choice. The initial three-month enrollment window has since been extended until August 15.

Just weeks later, Congress passed the president’s COVID-19 relief plan, which “pumps up” subsidies for insurance coverage purchased through HealthCare.gov. The additional assistance could save patients hundreds of dollars on their monthly premium.

Then, in March, the Centers for Medicare and Medicaid Services walked back a controversial proposal that would have weakened Medicare protections on six classes of medications for high-risk diseases including movement disorders, cancer and mental illness. 

What’s next? If advocates have their say, perhaps it will be revisiting federal policy on co-pay cards.  

After flip-flopping about how patients can benefit from co-pay cards, CMS issued a final rule on the matter in May 2020. It said health plans do not have to apply the cards’ value toward patients’ annual deductible. The cards can still discount the cost of medication. But patients may be surprised at the pharmacy pick-up counter when the co-pay card balance runs out and the full balance of their annual deductible is due. 

Health plans’ policy of not crediting co-pay cards’ value toward the annual deductible is called a co-pay accumulator adjustment program.

These programs can pose real challenges for patients. Research shows that even a nominal increase in out-of-pocket cost leads patients to abandon their medications or not take them as prescribed. 

Perhaps that’s why the concept of reducing out-of-pocket drug costs has bipartisan support. Last August, Representatives A. Donald McEachin (D-VA), Rodney Davis (R-IL) and Bonnie Watson Coleman (D-NJ) introduced a bill to protect patients from high out-of-pocket prescription drug costs during the COVID-19 pandemic. While the bill didn’t pass, it signals that elected officials from both sides of the aisle are committed to standing with patients on this issue.

The momentum generated by the administration’s health policymaking presents an important opportunity for continued improvements. There’s no better time than the present for the Biden administration to work with Congress to address the effect that co-pay policy has on patients’ pocketbooks – and their health.

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