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A letter to The Honorable Drew Ferguson, U.S. House of Representatives

The Honorable Drew Ferguson

U.S. House of Representatives

2432 Rayburn House Office Building

Washington, DC 20515

Dear Representative Ferguson,

On behalf of Georgia patients and their families, nurses, and physicians, we commend you for your leadership on issues that improve health care access and affordability for Georgia communities. Amid the health and economic challenges that our neighbors are facing every day, it is imperative to find solutions that help Georgians afford the treatments and services they need to manage their health.

We sincerely ask for your support of HR 4822 in the 118th Congress to address deceptive health insurance and pharmacy benefit manager (PBM) practices. that hinder patients access and affordability to the medications and treatments they critically need.

On behalf of the patients we serve, at ARxC/Rx in Reach GA Coalition, we ask you to work across the aisle on this important bipartisan initiative to support real PBM reform like patient pass thru and delinking PBM compensation from list prices and utilization levels. We stand ready to work alongside you in this effort to protect the health and well-being of Georgians and all Americans.

Many patients rely on assistance programs to access and adhere to their prescription medications. This is especially true for patients who use copay assistance for medications for which there are no generic equivalents. In fact, the vast majority (79%) of brand medications with available copay assistance do not have a generic equivalent.i Patients support HR 4822 because it:

  • Codifies Transparency in the Coverage Act

  • Provides PBM transparency to plan sponsors, including copay assistance reporting

  • Reports on transparency tools and data requirements

  • Limits cost sharing to lower of “average net price” or cash price in Part D between deductible & OOP cap

  • Sets new requirements for off-campus HOPD

  • Appears to impose site-neutrality on certain hospital-based outpatient departments

  • Establishes requirements for prior authorization on services in MA plans

  • Allows extension of certain direct spending reductions: phase down of sequestration cuts

To increase their profits, health insurers and PBMs are essentially double dipping into copay assistance meant for patients in need and are not passing rebate savings to patients at point of sale. This can have alarming consequences, as research shows a majority of patients (69%) abandon treatment at the pharmacy when out-of-pocket costs exceed $250.ii

As advocates for diverse Georgia patient communities and the providers who care for them, we fully support the Health Care Price Transparency Act, HR 4822 and federal efforts to ensure copay assistance counts towards patient cost-sharing requirements. This legislation builds on the efforts of 16 states – including Georgia – and Puerto Rico that have already passed policies to ensure copay assistance counts towards patient out-of-pocket cost responsibilities. Also, our Georgia legislation, Lowering Prescription Drug Costs for Patients Act, HB 343, ensures the savings negotiated by PBMs to reduce prescription drug prices, called “rebates”, will be shared with patients. These rebate savings will lower prescription drug price at the pharmacy counter.

Absent congressional action, health plans and PBMs will continue to take advantage of the most vulnerable populations in our healthcare system who rely on medically necessary medications to stay alive and well.

The Rx in Reach Georgia Coalition of 45 members stands ready and eager to champion this bipartisan policy and build support for legislation that will make a meaningful difference to help patients access and afford their medications.

Thank you for your leadership for Georgians and for patient communities across the country.

Dorothy Leone-Glasser, RN, HHC.

Executive Director, Advocates for Responsible Care (ARxC)

Project Lead, Rx in Reach GA Coalition

Chair, Center for Global Health Innovation (GA Bio) Patient Advocacy Alliance 404-633-5843 - office 678-778-3614 - cell

Facebook: Advocates for Responsible Care

Twitter: @ARxCAdvocates

Facebook: Rx in Reach GA

Twitter: @RxinReachGA

i USC Leonard D. Schaeffer Center for Health Policy & Economics. “A Perspective on Prescription Drug Copayment Coupons.” February 2018.

ii IQVIA. “Patient Affordability Part Two: Implications for Patient Behaviors & Therapy Consumption.” May 2018.


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