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Copay Accumulator Lawsuit Comes To An End; Will Ruling Be Enforced?

 
• By Angela Maas

The ball is now in the federal government’s and state insurance commissioners’ courts to enforce a district court ruling after HHS stops its appeal. As groups that brought the suit press CMS for guidance, they also eye complaints with DOL and class-action suits.

out of focus pharmacy shelf
• Source: Shutterstock

An ongoing lawsuit over the use of copay accumulators is drawing to a close following the defendants’ and plaintiffs’ motions to dismiss their appeals.

The ball is now in the federal government’s and state insurance commissioners’ courts to enforce a district court judge’s ruling, which states that manufacturer assistance must be counted toward patients’ out-of-pocket

Key Takeaways

  • Federal government’s commitment to enforcing the ruling is unclear, especially because HHS initially appealed it.

  • Groups that brought the suit want government to issue guidance that manufacturer assistance must be counted toward patients’ out-of-pocket responsibility except for brands with generics

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