Drug Cost-Sharing Limits Could Be Strengthened In Self-Insured, Large Group Plans In Upcoming Rule

03 Apr 2024

Proposal would extend the reach of CMS policy for drugs covered by individual and small group plans and could be an important step toward reining in copay maximizers and alternative funding programs in the commercial market.

Biden Administration copay steps are tentative so far, but a future rule is planned. • Source: Shutterstock

The Biden Administration is planning to extend some protections for the lifetime and annual cost sharing limits for drugs provided under the Affordable Care Act to a broader universe of commercial insurance plans.

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