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July 16, 2015

Patient Groups Encourage CMS to Post Accurate OOP Costs

2015-07-16 | June 24, 2015

(Washington, DC) More than 103 patient, provider and consumer organizations jointly encouraged the Centers for Medicare and Medicaid Services (CMS) to include accurate drug-specific out-of-pocket (OOP) costs in the proposed cost estimator under development for the federally-facilitated marketplace for the 2016 enrollment period.

In a letter to Kevin Counihan, Director and Marketplace CEO for the Center for Information and Insurance Oversight, the organizations note that “the success of the marketplaces will only be fully realized if people with chronic diseases and disabilities and their family caregivers have access to tools that enable them to make properly informed purchasing decisions.

The organizations recommend that the proposed calculator must 1) reflect real formularies with coverage and tier placement information, 2) allow patients to enter their medicines, and 3) use approximate negotiated prices of these drugs.

“The more patients know about their upcoming out-of-pocket costs, the more they can properly plan for their own health care and secure their futures,” said George Dahlman, NPAF Executive Vice President.  “We strongly urge CMS to promote as much cost transparency as possible and help patients attain both physical and financial security.”

For the full text of the letter, please click here.