The federal government has dropped its appeal of a court decision that could affect health insurance companies’ use of copay accumulator programs. The Justice Department on Tuesday withdrew its appeal of a September ruling by the U.S. District Court for the District of Columbia in favor of three patients and three patient advocacy groups.
The Biden administration has withdrawn its appeal of a district court decision to throw out the co-pay accumulator provision in the 2021 exchange rule, a move the plaintiffs in HIV+Hepatitis Policy Institute v. HHS hope indicates the government will enforce the 2020 policy that barred use of the accumulators for brand drugs without generics.
The Biden administration dropped its appeal Tuesday evening of a court ruling striking down an HHS rule on cost-sharing. A 2021 rule had allowed insurers not to count coupons from drugmakers toward patients’ maximum deductibles and out-of-pocket costs, but a federal judge struck it down in September. The administration had appealed that decision.
The court ruling, which ends most co-pay accumulators, in combination with CMS’ proposal to end the EHB loophole, will also stop use of co-pay maximizers–at least for individual and small group plans, the Institute points out in its comments. “It is critically important for the federal government to clarify that this also pertains to large groups and self-insured plans in order to put an end to copay maximizers,” the HIV+Hepatitis Policy Institute adds.
HIV+Hepatitis Policy Institute provides CMS with a long list of plan sponsors and vendors that appear to be engaged in the practice, which the group argues circumvents the cost sharing protections provided by the Affordable Care Act for hundreds of drugs.