Copay assistance provides a safety net to help patients afford and adhere to medically-necessary medications. But, the Centers for Medicare & Medicaid Services (CMS) Best Price Rule, finalized by the Trump administration in 2020, threatens patient access to these critical programs. If implemented, the final rule would allow insurers and pharmacy benefit managers (PBMs) to undermine copay assistance through copay accumulator adjustment programs that block patient assistance from counting towards a patient’s deductible and out-of-pocket cost-sharing requirements. Watch this virtual briefing to learn about the value of patient copay assistance programs and how you can get engaged to protect communities from the unintended consequences of the CMS Best Price Rule.
A discussion on Chronic Care Policy Alliance’s priorities and tips on how to reach out to elected officials.
HIV+Hep’s Carl Schmid, a consumer representative to the National Association of Insurance Commissioners (NAIC), presents to the NAIC PBM subgroup, along with ACSCAN’s Anna Howard, on how PBM’s impact patient access and affordability of prescription drugs.
HIV+Hep’s Carl Schmid’s presentation before the NAIC Regulatory Framework Task Force on the value of copay assistance for Rx, state laws that ensure copay assistance counts, and ways to mitigate any potential conflicts with those state laws with IRS/Health Savings Account issues.
Details the harmful impacts copay accumulators have on drug adherence and patients costs, federal and state actions taken to date to ensure copay assistance counts, and advocacy opportunities at the federal and state levels patient groups can engage in relative to copay accumulators.