1. Pink Sheet

Copay Accumulators: Pending CMS Reg May Offer More Clarity After Judge Limits Scope

 
• By Cathy Kelly

Programs only allowed for brands with generic competition under court ruling, but related programs such as copay maximizers and so-called ‘alternative funding’ programs are not directly impacted by the decision.

Decision Goes A Long Way Toward Curtailing Practice, Patient Groups Say • Source: Shutterstock

After a federal court vacated the Centers for Medicare and Medicaid Services rule that allows commercial insurers and pharmacy benefit managers to broadly implement copay accumulator programs, stakeholders are looking to possible modifications of a pending rule for clarification of how payers may be able to use the mechanism.

Copay accumulator programs are used by commercial insurance plans to prevent manufacturer assistance from being counted

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