not used title

not used title

PhRMA submitted comments this week in response to the Department of Health & Human Services (HHS) proposed rule on the Nondiscrimination in Health Programs and Activities. As outlined in our comments, PhRMA supports many policies in the proposed rule that aim to combat discrimination in health programs and activities, including broad application of nondiscrimination provisions, promoting health equity and preventing discriminatory benefit designs. PhRMA also urges HHS to ensure patients are adequately protected from discriminatory health plan features that are used by health plans, pharmacy benefit managers (PBMs) and related entities to exploit cost-sharing assistance or patient assistance programs to benefit their bottom lines.

Our comments include details about how middlemen like health plans, PBMs and related entities are using schemes to exclude the value of patient cost sharing from a patient’s deductible or annual limit on out-of-pocket costs when they use manufacturer cost-sharing assistance like coupons to pay for their medicine. Some middlemen are using charitable programs meant for the uninsured or underinsured rather than covering medication for patients with disabilities or living with chronic conditions. Here are quotes from our letter showing how HHS can curb three of these schemes that hurt patients, especially those dealing with chronic diseases:

• Accumulator adjustment programs: “When accumulator adjustment programs are implemented by health plans, they can substantially increase patients’ out-of-pocket costs, increasing financial burden and health risk, especially for those with serious and chronic illnesses. Thus, accumulator adjustment programs can undermine medication adherence, which can lead to negative health outcomes for patients and increase overall health care costs… There is no clinical basis for this disparate treatment. Indeed, it treats enrollees worse simply because they have significant health needs that require certain drugs.”
  
  
• Copay maximizers: “Copay maximizer programs can discriminate against individuals living with chronic conditions by imposing higher cost sharing on their medications unless a patient enrolls in a copay maximizer program… Copay maximizer programs also require patients to access their medication only at preferred specialty pharmacies, which can have a discriminatory impact on individuals living with chronic conditions, and in particular, patients with chronic conditions living in areas in which they may only have access to one or two independent pharmacies serving their area."
  
  
• Alternative funding programs: “Alternative funding programs allow commercially insured patients, who otherwise may not be eligible for the manufacturer charities or foundations, to access funds intended for uninsured or underinsured patients. This in turn may cause patients with financial needs to compete for limited resources or funds and enhance the potential for discrimination against patients with disabilities and prescribed specialty products. These programs only exist for specialty drugs and thus disproportionately affect individuals living with chronic conditions who need these life-saving specialty medications.”

The solution is clear: HHS should find accumulator adjustment programs, copay maximizers, alternative funding programs and any other scheme that health plans, PBMs, or third parties use to undermine the value of cost-sharing assistance or patient assistance programs intended for patients as examples of presumptively discriminatory practices. They disproportionately impact individuals and families living with chronic conditions, including those with disabilities. We stand ready to work with this administration to hold health plans and PBMs accountable to protect patients from discriminatory health plan features. Read the full comment letter here.

Emilie Signora

is a manager of public affairs at PhRMA focusing on the cost and value of medicines, as well as media executive visibility work. She previously worked for the U.S. Chamber of Commerce’s communications team. She received a B.A. in Communications from George Washington University. Outside of the office, Emilie enjoys traveling and spending time with her family.

Emilie Signora

New poll: 2 in 3 voters prefer a candidate committed to lowering health insurance premiums

September 18, 2026

What AARP isn’t telling seniors about MFN

August 24, 2026

Policymakers should improve patient access and reject price controls

August 18, 2026

Insurers blame GLP-1s for rising costs. The data tells a different story.

August 14, 2026

The FTC’s PBM enforcement actions gave us a glimpse behind the curtain; it’s time to let the light in.

August 7, 2026

Nearly 1 in 4 patients initially denied access to IRA medicines

August 6, 2026

Message to USAging: Providers are raising concerns about coverage barriers

July 22, 2026

New PBM principles don't change the fundamental challenge: Access to lower-cost medicines

July 10, 2026

340B’s reality: A booming business for hospitals, pharmacies and corporate giants

June 25, 2026

Insurers are blaming medicines for premium hikes in Massachusetts. The state's own data suggests otherwise.

June 24, 2026

Briefing: Capitol Hill panel on "Healthcare Denial Crisis in America"

April 24, 2026

Survey confirms too many insured Americans face barriers to reliable health care

April 22, 2026

70% DENIED: How insurance denials are delaying and preventing care for millions of Americans

April 14, 2026

Hospitals drive nearly 80% of the U.S. health spending gap

March 25, 2026

Insurers routinely block seniors’ access to medicines in Medicare Part D

March 18, 2026

No hassle, hidden markups or fees: AmericasMedicines.com

February 19, 2026

The Federal Trade Commission (FTC) takes important action to highlight and curb PBM abuses

February 17, 2026

Separating fact from fiction in the medicine supply chain

February 11, 2026

50-state poll says Americans are concerned that hospital markups hurt patients

January 27, 2026

Three things you should know from the insurer CEO congressional hearings

January 26, 2026

Can’t get your medicine? Don’t count on your insurer.

January 15, 2026

Stop, collaborate and re-evaluate: ICER’s pricing report

November 14, 2025

California’s landmark PBM crackdown: A wake-up call for reform

November 13, 2025

Middlemen mark up drug prices and keep discounts meant for you

November 10, 2025

Putting patients first: Breaking down barriers to care

October 28, 2025

Direct purchase programs can lower costs for patients

October 20, 2025

PBMs say they want lower priced medicines, so why don’t they cover them?

October 7, 2025

Historic biopharmaceutical investments: A prescription for America’s future

September 29, 2025

Why states struggle to deliver savings: Middlemen and 340B siphon dollars from patients and states

September 15, 2025

PBMs are hiding hurdles to essential care

August 20, 2025

New study: PBMs and commercial insurers are quietly blocking prescription access

July 30, 2025

North Carolina puts patients first with rebate pass-through law

July 29, 2025

PBMs, not patents, are blocking access to lower-cost medicines

July 23, 2025

Medicare Part D plans initially denied medicines for more than 70% of patients in four chronic disease areas

June 16, 2025

New “Balance the Scales” campaign highlights why Americans pay more for prescription medicines

May 21, 2025

How the 340B hospital markup program and PBMs drive up costs for U.S. patients

May 16, 2025

Foreign first pricing schemes don’t address why Americans pay more

May 15, 2025

The AHIP premium dollar corrected (again)

May 8, 2025

PBMs launch new ad campaign to block reforms

May 5, 2025

When middlemen own it all, patients pay the price

April 10, 2025

3 myths critics get wrong about intellectual property

March 28, 2025

New report finds more abuse of 340B program by hospitals and drug middlemen

March 24, 2025

A closer look at how health care consolidation drives up patient costs, creates barriers to care

March 17, 2025

Health care practitioners sound the alarm on middlemen-imposed barriers to patient care, need for policy change

March 13, 2025

Congress Keeps PBMs in the Hot Seat

March 6, 2025

Wrapping up the J.P. Morgan Healthcare Conference

January 16, 2025

FTC finds PBMs make billions in profit from marking up cancer, other critical generic drugs

January 14, 2025

PhRMA CEOs Tee Up Next Week's Health Care Conference

January 11, 2025

New study: Entities that don’t make medicines get half of what is spent on those medicines

January 7, 2025

Three things to know about 340B contract pharmacies

November 12, 2024

The PBM industry's desperate attempt to stop reform

November 12, 2024

PhRMA launches new ad calling for Congress to make sure savings go to patients, not PBMs

November 11, 2024

Reimagining patient access through meaningful policy reform

November 5, 2024

ICYMI: Grounding policy reforms in real lived patient experiences is key to improving outcomes

October 31, 2024

New PES survey: Out-of-pocket costs lead key health care priorities ahead of the November election

October 30, 2024

Guest Post: My health care vote

October 29, 2024

Insurers continue shifting more costs on to patients

October 28, 2024

Americans speak out on health insurance barriers and need for policy change, according to the latest Patient Experience Survey

October 28, 2024

ICYMI: The powerful companies driving local drugstores out of business

October 25, 2024

Hispanic Heritage Month: Fighting for Hispanic patients

October 7, 2024

PBMs and insurers off the hook: Sen. Sanders’ selective hearing on drug costs

September 24, 2024

Key voter insights two months from Election Day

September 10, 2024

Patient priorities in the 2024 election

September 10, 2024

Don’t put the government between patients and their medicines

August 7, 2024

Voters across all 50 states want state policymakers to focus on health insurance and PBM practices

July 30, 2024

WTAS: Voters voice concerns about PBM abuses, call on policymakers to act

July 19, 2024

PhRMA launches new ad in campaign exposing ways middlemen drive up costs

July 17, 2024

FTC report confirms PBMs profit at the expense of patients

July 10, 2024

New 50-state poll Americans want to hold health insurers and PBMs accountable for high out-of-pocket costs and other practices

July 9, 2024

ICYMI: Hidden markups at mail-order pharmacies increase costs for employers

July 2, 2024

The IRA could lead to higher out-of-pocket costs for 3.5 million Medicare patients in 2026

June 25, 2024

ICYMI: What patients care about this election year

June 24, 2024

ICYMI: The Opaque Industry Secretly Inflating Prices for Prescription Drugs

June 21, 2024

ICYMI: Health care policy should be driven by patients, not politics

June 10, 2024

PhRMA Warns Federal Agencies: Consolidation and vertical integration among insurers, PBMs, and hospitals threaten patients

June 5, 2024

ICYMI: Innovation transforms lives but misguided federal policies threaten patient outcomes

May 30, 2024

Ongoing federal probes shed light on PBM and insurer practices

May 20, 2024

Critics repeat same, misleading narrative on potential “costs” of new medicines

May 7, 2024

WTAS: The consequences of consolidation and vertical integration

May 6, 2024

IRA is already negatively impacting access to medicines in Part D

April 25, 2024

Insurance data: PBM reform has no material impact on premiums

April 24, 2024

New study finds insurers and PBMs increasing access restrictions in Medicare Part D

April 16, 2024

3 Takeaways from POLITICO’s Health Care Summit

April 3, 2024

PBMs using 340B program to drive profits at patients’ expense

March 28, 2024

Four years later, Maryland board still hasn’t delivered for patients

February 12, 2024

Setting the Record Straight: Comparing U.S. drug prices to those in foreign countries hurts patients

February 7, 2024

How the 340B program became a PBM giveaway

December 11, 2023

ICYMI: When middlemen get in the way, it’s the patients who lose

December 5, 2023

Get the facts on PCMA’s newest attempt to avoid accountability

December 4, 2023

Increased use of prior authorization in Medicaid is blocking access for patients

November 28, 2023

ICYMI: WSJ — Same Drug, Two Prices: Why the Higher Price Prevails

November 15, 2023

ICYMI: 3 takeaways on the IRA’s unintended consequences from America’s Physician Groups’ 2023 annual fall conference

November 6, 2023

One year to Election Day: Four voter priorities to watch

November 6, 2023

ICYMI: Scott LaGanga and Matt Salo deliver a State of the Industry Report

October 25, 2023

New poll shows strong bipartisan support for PBM reform

October 20, 2023

4 truths about state government price setting

October 10, 2023

ICYMI: Government watchdog report finds patients in Medicare Part D paid billions more for medicines than insurers and PBMs

September 28, 2023

Medicare Prescription Payment Plan will benefit patients if implemented correctly

September 21, 2023

New analysis shows PBMs use fees as a profit center

September 18, 2023

It’s PBMs, not patents, blocking competition 

September 14, 2023

New PhRMA ad exposes yet another way PBMs get between patients and their medicines

September 5, 2023

Navigating the Patient Experience Survey: Protecting Lifelines to Access and Innovation

July 26, 2023

Three things to know from the latest Patient Experience Survey

July 20, 2023

ICYMI: PBM exec admits choosing profits over patients

June 2, 2023

Insulin: Key Facts on Access & Affordability

May 10, 2023

4 key facts on medicine prices and spending

May 9, 2023

4 Things to know about PhRMA’s new 50-state poll

May 4, 2023

Americans want state policymakers to lower out-of-pocket costs

May 1, 2023

New PhRMA ad campaign sheds light on PBM abuses

May 1, 2023

Three facts about health care spending

April 25, 2023

AHIP’s latest misinformation campaign & what it’s trying to hide

April 24, 2023

ICYMI: PhRMA President and CEO Stephen J. Ubl discusses patient affordability

April 7, 2023

States can support access to medicine as COVID-19 Public Health Emergency ends

April 5, 2023

Arkansas puts patients first with new share the savings law

April 4, 2023

Key Trends: Patient experience data reveal how insurers and middlemen impose barriers in health care

March 29, 2023

Insurer and PBM tactics are shifting higher costs to patients with chronic and complex conditions

March 2, 2023

Holding pharmacy benefit managers accountable

February 23, 2023

Stopping pharmacy benefit managers from “gaming the system”

February 22, 2023

Senate hearing to examine bipartisan reforms to rein in middlemen

February 16, 2023

Minnesota lawmakers are letting PBMs off the hook, and threatening patients’ access to medicines

January 31, 2023

ICYMI: PhRMA kicks off the year at the 2023 J.P. Morgan Health Care Conference

January 19, 2023

ICYMI: PhRMA COO Lori Reilly speaks about the health care agenda for the next Congress

December 9, 2022

In their own words: Financial barriers exacerbate access challenges for insured Americans

December 8, 2022

Putting Delaware patients first: Protecting Patient Assistance Programs

November 22, 2022

Medicare Part D open enrollment and what recent changes mean for beneficiaries

November 17, 2022

New data show how insurers and middlemen shift Rx costs onto patients

November 16, 2022

In their own words: Insured Americans struggle to navigate complex coverage

October 26, 2022

Many seniors are paying more for Part D medicines than their insurer

October 18, 2022

Busting 3 Myths About Copay Coupons

October 5, 2022

Mental Illness Awareness Week – A time for reflection

October 3, 2022

A key fact the White House is reluctant to admit

September 27, 2022

A key fact the White House is reluctant to admit

September 27, 2022

Navigating the patient experience: Burdens and barriers standing between patients and their care

September 12, 2022

Making coupons count for patients at the pharmacy counter

August 25, 2022

Insulin and reconciliation

August 15, 2022

Making coupons count for patients with HIV

August 8, 2022

The Senate’s latest price setting proposal will undermine: Our health care system

July 28, 2022

The Senate’s latest price setting proposal will undermine: Patient access to medicines

July 26, 2022

Survey Says: Prescription drug prices are not fueling inflation concerns for Americans

July 22, 2022

Putting patients first at the state level — A conversation with Mark Reisenauer, President of Astellas Pharma US

July 14, 2022

Patients win as West Virginia implements first-in-nation share the savings policy

July 8, 2022

3 things voters are concerned about when it comes to their health care coverage

July 7, 2022

Copay assistance is a lifeline for patients. So why are insurers blocking it?

June 29, 2022

Patients support state action requiring PBMs and insurers to share savings and cap costs for medicines

June 16, 2022

New poll shows voters sounding the alarm on health insurance companies and PBMs

June 6, 2022

PhRMA warns of the growing influence of middlemen over patient access and out-of-pocket costs for patients

May 31, 2022

Report finds PBMs are increasingly restricting patient access to medicines

May 25, 2022

ICYMI: PhRMA COO Lori Reilly spotlights efforts to improve health care in 2022 and beyond

May 9, 2022

Study finds insurance barriers disproportionately burden patients with chronic illness

May 4, 2022

What’s really happening when it comes to prescription drug costs

April 27, 2022

5 public opinion polling trends to watch

April 22, 2022

Analysis: States can help patients save nearly $1,000 annually on their medicines

April 21, 2022

New analysis confirms hospitals markup prices for oncology therapies

April 21, 2022

How standardized plans can improve patients’ access to medicines

April 18, 2022

The patient experience: Uncovering the barriers to care for insured Americans

March 28, 2022

Correcting the record: Putting medicine costs and spending in context

March 24, 2022

Sharing rebates can save Americans with diabetes 500 each year and improve adherence

March 16, 2022

Veterans Affairs 101: Three charts show how the VA system differs from Medicare

March 11, 2022

If drug prices are growing below the rate of inflation, why are patients still feeling the sting at the pharmacy?

March 8, 2022

The patient experience: Insurance barriers continue to impede access to health care, especially among the country’s underserved

February 28, 2022

PhRMA submits comments urging CMS to withdraw coverage proposal

February 11, 2022

Medicaid 101: Three charts on access and spending

February 3, 2022

Government price setting won’t stop insurers from shifting costs to patients

February 2, 2022

New comments outline ways to counteract cost-shifting insurance trends

January 28, 2022

Patients need to pay less for their medicines. States can help.

January 26, 2022

It’s a new year, but sadly Congress is still pursuing flawed price setting policies

January 25, 2022

New poll of all 50 states and 435 Congressional Districts shows perils of so-called Medicare “negotiation”

January 25, 2022

CBO reaffirms our innovation ecosystem leads to improved lives, long-term savings

January 21, 2022

New study finds more than half of brand medicine spending goes to the supply chain and others

January 7, 2022

Making medicines more affordable: Making insurance work like insurance

December 8, 2021

Insurance design barriers can impact patient adherence and can lead to poor health outcomes

November 23, 2021

What is missing in the current drug pricing plan

November 23, 2021

ICYMI: PhRMA CEO speaks at STAT Summit about government price setting

November 19, 2021

Making medicines more affordable: Sharing savings at the pharmacy counter

November 19, 2021

Three things to know about so-called Medicare negotiation polling

November 18, 2021

Making Medicines More Affordable: Making coupons count

November 5, 2021

What they are saying: Government price setting for medicines is not the answer

November 4, 2021

Four things to know from IQVIAs latest report

October 29, 2021

The patient experience: Insurance design hurdles lead to access issues for too many Americans

October 28, 2021

The patient experience: Out-of-pocket costs are driving patients affordability and access challenges

October 19, 2021

To drive up profits, hospitals continue unnecessary medicine mark-ups, burdening patients, employers and health care system

October 14, 2021

New report shows 3 in 10 Americans that have insurance still face a financial barrier to care

October 7, 2021

Industry leaders discuss the impact of the drug pricing debate

September 23, 2021

Five reasons tying VA prices to Medicare Part D misses the mark

September 22, 2021

America’s biopharmaceutical companies to Congress: Government “negotiation” is the wrong approach

September 15, 2021

ICYMI: Event spotlights how we can make Medicare work better for patients

August 4, 2021

The future of the rebate rule: Will policymakers stand with patients?

August 2, 2021

Celebrating Medicare’s 56th anniversary

July 30, 2021

3 factors impacting medication adherence for patients with diabetes

July 20, 2021

New reports shed light on key facts about medicines and affordability

June 8, 2021

Out-of-pocket trends in Medicare Part D show rising costs for seniors

May 24, 2021

Study finds nearly half of payers believe innovative contracts can lead to lower patient out-of-pocket costs

May 17, 2021

New data from insurers show detriments of copay accumulator adjustment programs

April 28, 2021

West Virginia becomes the first state to lower patient costs by sharing the savings

April 20, 2021

Nearly 40% of commercially insured patients face half their annual out-of-pocket expenses from just one health care encounter

March 2, 2021

Top five issues voters want addressed in the administration’s first 100 days

February 18, 2021

Insurers shift medicine costs to patients with severe chronic illnesses

February 1, 2021