HIV+Hep in the News

Carl Schmid of the HIV+ Hepatitis Policy Institute says plaintiffs now want the administration to issue guidance affirming the 2020 policy that bars co-pay accumulators for brand-name drugs with no generic equivalent is the law of the land and drop any plans to appeal the ruling. Schmid also notes that state insurance commissioners will be enforcing the ruling and that anyone who is harmed by co-pay accumulator would have a private right to action.

“The 2020 rule is in effect — there’s no doubt now about that,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, tells AIS Health, a division of MMIT. “They’re the ones who asked for the clarification,” he says of the Biden administration, “and they got it…so hopefully now they will change their tune and enforce the provision.”

The district court judge in the copay accumulator case has cleared the air. Judge John D. Bates, of the U.S. District Court for the District of Columbia, not only reiterated that he agrees with the three patient groups who were plaintiffs in the case. The groups brought suit to dissolve the government’s 2021 accumulator rule, which had allowed insurers to not count prescription drug co-pay assistance toward a beneficiary’s out-of-pocket costs for branded drugs that don’t have a generic equivalent.

Almost two months after a U.S. district court judge struck down a federal rule allowing health plans to not count copayment assistance against members’ out-of-pocket costs, ruling in favor of patient advocacy groups in a lawsuit against HHS, the agency has signaled that it will not — at least for the time being — take action against plans based on how they treat that assistance. The agency in a recent court filing also said it plans to issue rulemaking in response to the September ruling and requested feedback from the judge on his decision. Shortly thereafter, the plaintiffs appealed the government’s move.