Washington Update, May 2019

Washington Update

CMS Releases New Policy to Limit Co-pay Accumulator Programs
By Johanna Gray

On April 18, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters Rule for 2020. This is an annual rule that sets policies for private insurance plans. In the 2020 Final NBPP Rule, CMS finalized a policy that only allows plans to implement co-pay accumulator programs in limited scenarios – only for brand name drugs when there is a generic alternative, and only when an appeals or exceptions process has found that the brand name drug is not medically necessary. Co-pay accumulator programs essentially disallow co-pay assistance from counting towards a person’s out-of-pocket (OOP) maximum. CMS has specifically said that in cases where there is no generic alternative, co-pay assistance should accrue to a person’s OOP max. Since our treatments do not have generic alternatives, this rule should significantly reduce the effects of co-pay accumulator programs for the bleeding disorders community starting in 2020.

We are very pleased that CMS has indicated that accumulator programs should not apply to our patients and products. Accumulator programs have been a growing concern for our patient community and many organizations including the Alliance have been involved in advocacy on a number of levels (federal, state, directly with payers). We have to acknowledge the leadership role that NHF played on the national level with the All Copays Count Coalition in seeking this change from CMS. We have sought more information from the Agency and from payers about how this new policy will be implemented. We will update the community as the situation is clarified.

Also in this Issue…

Notes from Joe
· Hill Day Recap

Legal Update
· External, Independent Audits of 340B Contract Pharmacies: Where do they come from? What are they? Where are they going?***

Payer Update

Alliance Update
· Alliance Seeking Director of Community Relations

Notes from the Community
· CDC Division of Blood Disorders Announces Next Public Health Webinar Series on Blood Disorders


Team Alliance Contact Information

We work for you! Please don’t hesitate to contact any of us with any questions or concerns:

Name Email Phone
Joe Pugliese joe@hemoalliance.org 215-439-7173
Sean Singh sean@hemoalliance.org 727-388-7326
Jeff Blake jeff@hemoalliance.org 317-657-5913
Jeff Amond amond@hemoalliance.org 608-206-3132
Johanna Gray, MPA jgray@artemispolicygroup.com 703-304-8111
Elizabeth Karan ekaran@feldsmantucker.com 612-202-3240
Roland P. Lamy, Jr. roland@hemoalliance.org 603-491-0853
Dr. George L. Oestrich, Pharm.D., MPA george@gloetal.com 573-230-7075
Ellen Riker eriker@artemispolicygroup.com 202-257-6670
Mark Plencner mark@hemoalliance.org 701-318-2910
Michael B. Glomb MGlomb@ftlf.com 202-466-8960
Theresa Parker theresa@hemoalliance.org 727-688-2568
Karen Bowe karen@hemoalliance.org 717-571-0266
Joel Bellucci webmaster@hemoalliance.org 727-504-0491