Copay Accumulators Get A Reprieve: Commercial Plans’ Use Will Not Be Restricted By CMS

Copay Accumulators Get A Reprieve: Commercial Plans’ Use Will Not Be Restricted By CMS – Yet

29 Nov 2023

US Health and Human Service Department questions recent federal court decision striking down the government’s policy of allowing plans to broadly exclude manufacturer copay assistance from counting toward patient deductibles or out-of-pocket maximums.

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The Centers for Medicare and Medicaid Services wants clarification from the federal court that recently ruled against the agency’s interpretation of the law when it comes to commercial insurance plans’ use of copay accumulators before it revises its current policy on such programs.

Key Takeaways

Government will not take enforcement action against copay accumulators used for brands without generic competition until it gets further clarification from federal court about a recent decision involving accumulator programs.

The Health and Human Services Department filed a motion with the US District Court for the District of Columbia...