Carl Schmid discusses discrimination in prescription drug formularies, demonstrating how some PBMs and private insurers violate ACA provisions and hurt patients by placing life-saving prescription drugs on higher cost tiers.
At Informa Connect’s Copay, Reimbursement and Access Congress, Carl Schmid discusses the litigation filed by HIV+Hep, the DLC, and the DPAC in the U.S. District Court for DC challenging a federal rule that allows health insurers to avoid counting the value of drug manufacturer copay assistance toward patients’ out-of-pocket cost obligations in violation of the ACA definition of and regulations for cost-sharing.
Carl Schmid discusses on a National Consumers League webinar current federal advocacy efforts to ensure that copay assistance for prescription drugs counts. This includes comments on two regulations, a congressional bill, and recent litigation initiated by HIV+Hep and two diabetes groups.
The HIV+Hepatitis Policy Insite, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed suit in the U.S. District Court for the District of Columbia challenging a federal rule that allows health insurers and pharmacy benefits managers to avoid counting drug manufacturer copay assistance toward patients’ out-of-pocket cost obligations. Due to increased deductibles and cost-sharing requirements, patients rely on copay assistance to help them afford their medications.
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.