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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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.
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.