HIV+Hep in the News

On January 16, the Centers for Medicare & Medicaid Services (CMS) & the U.S. Department of Health and Human Services (HHS) withdrew an appeal to a recent copay accumulator court decision, HIV+Hepatitis Policy Institute et al. v. United States Department of Health and Human Services, in the U.S. District Court for the District of Columbia (Court). The appeal had originally been filed in the case brought by patient advocates against CMS and HHS seeking to set aside the Court’s order after the Court held that the 2021 HHS rule giving insurers discretion to operate accumulator adjustment programs (Accumulator Adjustment Programs) was arbitrary and capricious. With this turnabout by the Biden administration, the 2020 Accumulator Rule is still in effect, which permits insurance plans to exclude only the value of manufacturer assistance from annual out-of-pocket cost-sharing maximum calculations for brand prescription drugs with an available and medically appropriate generic equivalent.

On January 16, 2023, the Department of Health and Human Services (“HHS”) dropped its appeal of the U.S. District Court for the District of Columbia’s September 29, 2023 decision that vacated a portion of the 2021 Notice of Benefit and Payment Parameters (“2021 NBPP”). The 2021 NBPP permitted (but did not require) plans and issuers to count direct support offered by drug manufacturers for prescription drugs (“Coupons”) toward the Affordable Care Act’s annual cost-sharing limit (“MOOP”). HIV and Hepatitis Policy Inst. et al. v. U.S. Dep’t of Health and Hum. Svcs., No. 22-2604, 2023 WL 6388932 (D.D.C. Sept. 29, 2023).