Copay Assistance Can Be Excluded From Medicaid ‘Best Price’ Without Strings Attached – US Court
Decision is a win for the Pharmaceutical Research and Manufacturers of America in lawsuit against the US Health and Human Services Department.
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Lawsuit highlights the lack of transparency into pharmacy benefit manager activities and how their programs can influence drug pricing. A Senate hearing on PBMs held shows increasing momentum behind a Federal Trade Commission study on potential anti-competitive activity in the market sector.
The regulatory provisions being challenged are part of a Trump-era “midnight rule” that could be changed by the Biden Administration before implementation, but PhRMA is not taking any chances about the future of copay assistance programs.
CMS final rule narrows definition of new formulations potentially subject to much higher Medicaid rebates and delays effective date of provisions targeting health plan copay accumulator programs.