Lawmakers pressed Department of Health and Human Services Secretary Xavier Becerra over the Biden administration’s stance toward Medicare Advantage, rural health and more during budgetary hearings this week.
Some lawmakers praised the administration’s commitment to key priorities like the Medicare drug price negotiations program. At times, members on both sides of the aisle grew exasperated at Becerra’s unwillingness to directly answer questions.
But an exchange with Rep. Buddy Carter, R-Ga., over copay accumulators more than 90 minutes into Becerra’s third day of testimony drew some of the toughest criticism yet from patient advocacy groups, leaving some to question where his loyalties lie and others wondering if he’s simply uninformed on the issue.
‘I think that the Secretary’s testimony was an embarrassment on multiple levels, and the department should be ashamed of its position and the statements made at the hearing,” said Bill Sarraille, a healthcare policy consultant, in a statement shared with Fierce Healthcare.
Copay accumulators are features within insurance plans and pharmacy benefit managers where manufacturers’ coupons do not count toward a patient’s deductible or out-of-pocket maximum.
“These copay accumulators are not being honored by the PBMs,” said Carter. “They’re pocketing them.”
Carter referred to an October court decision to strike down a policy allowing insurers to not count assistance toward a person’s out-of-pocket costs, unless the branded drug has a generic equivalent. The court said the policies hurt patients, including the plaintiffs in the case, by forcing them to pay more for prescription drugs.
The HIV+Hepatitis Policy Institute, one of the loudest voices on the issue, has since claimed the Biden administration is sympathetic to insurers, not patients.
In November, the feds appealed the December ruling before dropping the appeal in January.
Becerra repeatedly said in the hearing HHS would comply with the law and protect Medicare beneficiaries.
“This issue has absolutely nothing to do with the Medicare program,” said Sarraille.
Copay accumulators and maximizers are not used by Medicare patients, he explained. Under the anti-kickback statute, usage of coupons on a federal program beneficiary is illegal.
The advocacy group maintains the federal government is choosing to not enforce the court ruling, instead letting PBMs pocket the money at the expense of regular people, while ignoring a previous regulation that should now be in effect.
“Did the department comply? No. It said, in writing, to the court that it would not enforce the existing regulation,” said Sarraille. “It refused to protect patients and it refused to do so in the face of a regulation—its own regulation—that required exactly that.”
Becerra pushed aside Carter’s claims that copay accumulators negatively impact patient’s access to care.
“Give me a case where patients have been denied their drugs,” he countered.
In fact, the courts have already ruled in favor of the plaintiffs and agreed with claims that these practices are harmful to patients needing affordable drugs.
“Secretary Becerra is clueless about copay accumulators, our lawsuit (against his own department), and their impact on patients,” said Carl Schmid, executive director at HIV+Hepatitis Policy Institute, in a LinkedIn post. “He actually thinks this is a Medicare issue and has no negative impact on patients getting their drugs.”
Earlier in the hearing, House Energy and Commerce Committee chair Cathy McMorris Rodgers (R-OR), challenged Becerra on when HHS would enforce long-promised price transparency requirements for PBMs. He said action has been delayed to ensure the agency follows court rulings.
So why, Carter asked, is HHS not following the court ruling in the case of copay assistance? Furthermore, why has the Biden administration given strong push back on this issue?
“The most high-level overview answer is that we don’t know,” Chris Phillips, M.D., chair of the American College of Rheumatology’s committee, told Healio in March.
“This is unconscionable,” said Sarraille. “And Becerra is either oblivious to this or, worse, indifferent to it.”