Diversion of patient copay assistance by insurers, PBMs & third-party vendors

NAIC Prescription Drug Coverage (B) Working Group
May 19, 2025

Speaking to the NAIC Prescription Drug Working Group, Carl Schmid described how insurers, PBMs, and 3rd party vendors harm patients by not counting manufacturer copay assistance toward out-of-pocket costs as required under the ACA; which states have banned copay accumulators; and efforts to enforce the Court ruling that requires all copay assistance be counted for patients.

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