HIV+Hep in the News

Three patient advocacy groups are suing the Biden administration over a Trump-era rule that they argue has allowed insurers and pharmacy benefit managers to increase out-of-pocket prescription drug costs for consumers. The complaint, obtained by Bloomberg Law, alleges the rule conflicts with the definition of “cost-sharing” in the Affordable Care Act and federal regulations. The rule (RIN: 0938-AT98) was issued in 2020 by the Centers for Medicare & Medicaid Services and says health insurers don’t have to count copay assistance from drugmakers toward a patient’s annual limitation on out-of-pocket costs. The HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition allege the policy has allowed insurance companies and pharmacy benefit managers—the entities that manage prescription drug benefits on behalf of insurers—to collect funds from both patients and drugmakers while not using any of that money to alleviate the financial burden on patients.

Patient groups ‘left with no choice’ but to challenge federal regulation allowing commercial payers to bar manufacturer assistance with drug costs from being counted toward deductibles and out-of-pocket spending caps.