Lexology October 9, 2023
In a significant development with far-reaching implications for health plans and pharmacy benefit managers (PBMs), Justice John D. Bates of the U.S. District Court for the District of Columbia has recently struck down a federal rule that allowed health plans to use copay accumulator programs to exclude drug manufacturer copayment (Copay) assistance from a patient’s out-of-pocket costs. This ruling has significant implications for the way health plans and PBMs operate and interact with patients and copay assistance programs.
Overview of Copay Assistance Programs
For certain high-priced specialty drugs, pharmaceutical manufacturers have long offered free or reduced-cost medicine, discount cards, coupons, and other forms of assistance to help patients afford the medication. While this manufacturer assistance can come in many forms,...
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