Carl Schmid, executive director of the HIV+HEP Policy Institute, is hopeful that ongoing legal action the institute and two other organizations took against the government on the issue may lead to the change the group is pushing for, as he said patient advocates have seen “no action by the federal government on this issue.”
Copay coupons are currently banned by Medicare but allowed in the commercial market, including for Affordable Care Act plans. The final 2021 NBPP rule allowed enforcement of copay accumulator programs, and the agency has continued to permit the policy since then, despite long-standing objections from patient groups.