Decision on State Exchanges Will Aid Patient Access to Medications

National Health Council applauds HHS clarification on qualified health plans

WASHINGTON, Nov. 1, 2013 /PRNewswire-USNewswire/ -- The National Health Council (NHC) applauds the Department of Health and Human Services (HHS) for clarifying that health care coverage provided through state exchanges is a private service and not public aid.

An important benefit of the decision is that people with chronic diseases and disabilities will be able to continue using patient assistance programs (PAPs), including copayment assistance programs. People with chronic conditions typically have high out-of-pocket expenses and under the decision will be able to continue utilizing PAPs to access their medicines.

PAPs are created by pharmaceutical companies and nonprofit organizations to provide free or discounted outpatient medicines to people who are unable to afford them. For example, if a patient has a limited income or faces high-cost catastrophic care, the individual could better afford necessary drugs with the help of a PAP.

"For people with complex chronic conditions who rely on lifesaving medicines to live longer and better lives, this is a much welcomed decision," said NHC Chief Executive Officer Myrl Weinberg. "This ruling, combined with the essential health benefits and the patient protections guaranteed under the Affordable Care Act, presents us with a meaningful route for patients to get the medications they so desperately need."

A letter from HHS Secretary Kathleen Sebelius to U.S. Representative Jim McDermott, states: "The Department of Health and Human Services does not consider [qualified health plans provided through state exchanges], other programs related to the Federally-facilitated Marketplace, and other programs under Title I of the Affordable Care Act to be federal health care programs. This includes the State-based and Federally-facilitated Marketplaces; the cost-sharing reductions and advance payments of the premium tax credit; Navigators for the Federally-facilitated Marketplaces and other federally funded consumer assistance programs; consumer-oriented and operated health insurance plans; and the risk adjustment, reinsurance, and risk corridor programs."

Resources:

• Letter from Secretary Sebelius:  http://mcdermott.house.gov/images/The%20Honorable%20Jim%20McDermott.pdf
• Examples of PAPs: http://www.needymeds.org/indices/newuser.htm; http://www.pparx.org/en/prescription_assistance_programs
• About the NHC: www.nationalhealthcouncil.org

The National Health Council is the only organization that brings together all segments of the health community to provide a united voice for the more than 133 million people living with chronic diseases and disabilities and their family caregivers.

SOURCE National Health Council