1/18/23

The Biden Administration announced on Tuesday, January 16 th that the Justice department was withdrawing from an appeal in the Copayment Assistance Case. Late last year the District Court for the District of Columbia issued two rulings that overturned a previous Trump administration rule and made clear that the 2020 Notice of Benefits and Payment Parameters was in force. This rule requires copayment assistance to count toward patient cost sharing as long as there is no generic equivalent.

Patient groups were surprised when the administration originally sought to potentially move forward with an appeal. However, this move by the administration falls in line with other decisions such as from US Office of Personnel Management which refused to consider coverage plans that utilized copayment accumulators as cost containment mechanisms. “This is a major step forward for patients, but we must finish what we started with copay accumulator legislative bans in the states and Congress. Advocates have learned that these victories can be overturned by succeeding administrations” said Kim Phelan, COO of the Coalition for Hemophilia B.

Copayment accumulators are a tactic used by health insurance providers to prevent the use of copayment cards and copayment assistance to help a patient with a rare or chronic illness meet their maximum out of pocket cap. To learn more, please read the full story on Politico heres://subscriber.politicopro.com/article/2024/01/biden-administration-drops-cost-sharing-appeal-00135983.