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CAPD Comment Letter on HHS’ Notice of Benefit and Payment Parameters (NBPP)

Seema Verma, Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-9916-P
P.O. Box 8013
Baltimore, MD 21244-8013

Re: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans (CMS-9916-P)

Dear Administrator Verma,

Thank you for the opportunity to comment on HHS’ Notice of Benefit and Payment Parameters (NBPP) for 2021, published in February 2020. The Coalition for Affordable Prescription Drugs (CAPD) represents a broad-based group of employers, unions, health systems, public sector employees, retirees and the pharmacy benefit managers they work with to provide affordable, sustainable prescription drug coverage to their employees and members. As stakeholders with direct responsibility for ensuring access to affordable medicine, we strongly support the inclusion of policies that will lead to lower drug costs for American patients and the U.S. health care system into the final rule.

CAPD supports provisions in the proposed rule that will allow health plan sponsors flexibility on whether or not to count financial support offered by pharmaceutical manufacturers toward annual limits on cost-sharing. This flexibility extends and builds on guidance issued by the Departments of Health and Human Services (HHS), Treasury and Labor in August 2019 to allow plan sponsors flexibility in cases where an equivalent generic drug is not available, which CAPD also supported.

Support from pharmaceutical manufacturers for drug costs, which often comes in the form of so-called “co-pay coupons” or other financial incentives, are a powerful tool used by pharmaceutical manufacturers to distort the reality of their high prices to patients. They also serve to undermine the tools that plan sponsors and PBMs use to provide patients with lower-cost alternatives, including medically-equivalent generic drugs, biosimilar drugs, and therapeutically equivalent brand drugs. In the majority of cases, these coupons and forms of assistance needlessly inflate drug spending when lower-cost, equally effective alternatives are available, and serve to encourage the use of more expensive treatments across the health system. Further, co-pay coupons for branded drugs with generic bioequivalents are correlated with faster branded price growth.

One critical component to this policy is the flexibility the proposed rule allows plans in deciding whether or not to count this assistance, rather than creating a specific mandate. By maintaining the option, plans can allow patients to take advantage of this assistance in cases when a high-priced brand medication is medically necessary but lacks competition or appropriate alternatives because of monopoly protections.

We appreciate the opportunity to comment on the proposed rule and encourage CMS to continue to implement provisions that grant plan sponsors flexibility to lower beneficiary costs and push back on the high prices that pharmaceutical manufacturers set for their prescription drugs.

Debra Barrett

Executive Director

Coalition for Affordable Prescription Drugs