Dear [Member of Congress],
I am deeply concerned about the harms that a loophole in federal law have on patients. Health insurers and pharmacy benefit managers (PBMs) are exploiting the essential health benefits (EHB) provision of federal law to redesignate some prescription drugs – often specialty-sharing requirements and patient affordability protections.
These affordability protections were baked into federal law for a reason. While PBMs and insurers reap the benefits of this evaded responsibility with extra cash, vulnerable patients are left to bear the burden of high out-of-pocket costs for specialty drugs – drugs that rarely have a generic alternative.
In April 2024, the Departments of Health and Human Services (HHS) and Treasury took initial action in issuing a rule that protects patients with individual or small group health plans from the "EHB loophole." However, that rule does not automatically protect patients with large group or self-insured health plans – meaning that patients across the country are still at risk.
I urge the Departments of HHS, Labor, and Treasury to close the EHB loophole as soon as possible and ask Congress to raise their voice to ensure patient rights are protected and ensure insurers don't harm more patients. The health and well-being of countless Americans who depend on life-saving prescription medications are at stake.
Thank you for your leadership to protect patients and your attention to this urgent matter.
[Your comment here]
Sincerely,
[Signatory Name]
