Copay assistance

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U.S. government appeals drug copay assistance court ruling

Nov 28, 2023

“We can’t comprehend why the Biden administration, which has championed access and affordability of prescription drugs for the American people, would appeal this decision. By siding against patients who depend on prescription drugs and with insurers, they are allowing insurers to ‘double bill’ and extract more money from patients and drug manufacturers by implementing copay accumulators.” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, one of the plaintiffs in the lawsuit. “The court’s decision is very clear: copay assistance for prescription drugs without a generic equivalent must now count for patients.”

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Biden administration takes on insurer abuses in prescription drug coverage

Nov 16, 2023

“While we are pleased that CMS is taking steps to clamp down on insurers who are abusing the system by covering drugs without including them as part of essential health benefits, we are disappointed they are not directing payers to immediately count copay assistance, at a minimum, for brand name drugs without a generic alternative,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “While we understand that the case was recently decided, it will be important that CMS issue guidance that directs payers to comply now with the Court’s decision and ensure enforcement.”

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Court strikes down HHS rule that allowed insurers to not count copay assistance

Oct 2, 2023

In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three patients who depend on copay assistance and whose insurers implemented “copay accumulator” policies.

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Patient groups reply to government’s brief in landmark lawsuit challenging copay accumulators

May 1, 2023

The HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three patients filed their reply in support of their motion for summary judgment in the U.S. District Court for the District of Columbia in their ongoing lawsuit against copay accumulators. The suit challenges HHS’s 2021 Notice of Benefit and Payment Parameters rule, which permits insurance plans to refuse to credit copay assistance from drug manufacturers toward beneficiaries’ deductibles and out-of-pocket maximums.

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Amicus briefs filed in suit to end policy that prohibits copay assistance from counting toward patients’ out-of-pocket spending

Feb 10, 2023

Yesterday, 29 patient, provider, and consumer organizations representing a wide range of illnesses and health conditions filed an amicus brief in support of a case brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, the Diabetes Patient Advocacy Coalition, and three patients. Filed in the U.S. District Court for the District of Columbia, the lawsuit challenges the federal 2021 Notice of Benefit and Payment Parameters rule, which allows health insurers to avoid counting the value of drug manufacturer copay assistance toward patients’ out-of-pocket cost obligations. Plaintiffs recently filed a motion for summary judgment, asserting that the rule violates cost-sharing requirements mandated by the Affordable Care Act and is also arbitrary and capricious.

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