November 21, 2013
In recent years, many people living with serious illnesses have used a patchwork of financial assistance programs to gain access to lifesaving medications, including drug industry-provided co-payments, co-insurance, or other out-of-pocket discount cards and coupons. These programs are often the only means through which patients can afford the higher co-pays that insurance companies impose on expensive branded drugs without generic equivalents.
But these programs are at risk of becoming prohibited for Health Insurance Marketplace plans created under the Affordable Care Act (ACA), due to an erroneous interpretation of the federal anti-kickback statute. We believe this prohibition could cause an unintended public health crisis by removing a critical lifeline for thousands of people living with HIV, bar millions of people with hepatitis C from benefiting from the new short-course curative treatment combinations, and keep countless people with cancer and other debilitating and life-threatening illnesses from the treatment they need to stay alive. We fear this will be a major setback to the goals of the ACA.
We are asking that Secretary of Health and Human Services Kathleen Sebelius issue clear guidance to allow drug industry-sponsored assistance programs for drugs without generic equivalents in the ACA health plans, so that patients with serious illnesses can be protected from immediate and insurmountable out-of-pocket cost barriers as the nation's health care system adapts during the ACA transition.
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