HIV+Hep in the News

The HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed their lawsuit in August, alleging that the 2020 CMS rule conflicts with the definition of “cost-sharing” in the Affordable Care Act and federal regulations. Several groups have since filed amicus briefs in support of the challenge, including leading drug industry trade group the Pharmaceutical Research and Manufacturers of America and a coalition of 29 patient, provider, and consumer organizations. Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said he believes they have a “strong case.” He referenced the groups’ amended complaint, which argued that copay accumulator programs can harm patients like Pennsylvania resident Cynthia Regan, who pays more than $6,000 for a single month’s supply of AbbVie’s anti-inflammatory drug Humira. Regan’s health plan has a copay accumulator prohibiting her from using a $500 manufacturer coupon toward her deductible or annual out of pocket maximum, according to the complaint.

Carl Schmid, the executive director of the HIV and Hepatitis Policy Institute, is helping represent 42 million people nationwide experiencing copay accumulator issues relating to chronic illnesses in a federal lawsuit challenging the rule to allow health insurance companies to avoid counting copay assistance toward patients’ out-of-pocket obligations. He told the Deseret News that he hopes the lawsuit, filed in Washington, D.C., will “force the government’s hand” and make it acknowledge that copay accumulator policies go against regulations in the Affordable Care Act’s 2021 Notice of Benefit and Payment Parameters.

Patient advocates are also fighting the accumulator policy in court. Three patient advocacy groups — HIV+Hepatitis Policy Institute, the Diabetes Leadership Council and Diabetes Patient Advocacy Coalition — filed a lawsuit in August 2022 aiming to block companies from excluding patient assistance from OOP maximums, saying the HHS rule that allows the practice contradicts the definition of cost-sharing in the Affordable Care Act (ACA). In the lawsuit, the plaintiffs say the ACA requirement that patients pay co-pays up to a certain amount doesn’t mean it can be counted against them if they receive help paying their costs.