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Victory for patients reiterated–Court makes it clear: Rule requiring copay assistance to count now in effect

Dec 26, 2023

“We thank the Court for siding, yet again, with patients who struggle to afford their prescription drugs and rely on copay assistance,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, one of the plaintiffs in the lawsuit. “The Court has clarified what we have been asserting: the rule that states copay assistance must count is in effect. Now, that clear rule must be followed by insurers.”

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Patient Groups Explain to the Court Why Copay Assistance Ruling Must Be Enforced Now

Dec 12, 2023

Patient groups, after successfully challenging the U.S. government’s rule allowing insurers to not count prescription drug copay assistance towards patient cost-sharing, filed a brief yesterday explaining why the government must enforce the Court ruling. Additionally, the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three impacted patients filed their own appeal of the U.S. District Court ruling to the U.S. Court of Appeals for the D.C. Circuit.

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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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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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