Payers' Latest Attack On Copay Coupons: 'Accumulator' Programs
More payers are implementing programs that block manufacturer copay coupons for specialty drugs from being applied to deductibles and out-of-pocket maximums, exposing members to higher drug costs.
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Patient groups ‘left with no choice’ but to challenge federal regulation allowing commercial payers to bar manufacturer assistance with drug costs from being counted toward deductibles and out-of-pocket spending caps.
Annual payment rule for individual and group plans governed by Affordable Care Act proposes excluding drug manufacturer-sponsored copay assistance from out-of-pocket caps and seeks comments on use of reference pricing.
Member companies’ direct-to-consumer TV ads will direct patients to information about drug costs – including list price, estimated out-of-pocket costs for the drug, and availability of financial assistance – under a voluntary program that takes effect in April 2019; initiative falls short of mandatory list price disclosures proposed by Trump Administration.