Copay Maximizers May Be Restricted In Small Private Plans Under CMS Proposal: Will Broader Impact Follow?
The Centers for Medicare and Medicaid Services requests stakeholder feedback on how extensively copay maximizers are being used by insurers, which could help pave the way for restrictions on large employer and self-insured plans.
You may also be interested in...
US Health and Human Service Department questions recent federal court decision striking down the government’s policy of allowing plans to broadly exclude manufacturer copay assistance from counting toward patient deductibles or out-of-pocket maximums.
But the Centers for Medicare and Medicaid Services wants to see data first on how promoting coverage of the new obesity drugs would impact uptake, plan costs and beneficiary premiums.
Gaps and disputes around what the Affordable Care Act designates as ‘essential’ prescription drugs have allowed plans to provide more limited coverage of specialty medicines, some patient advocacy groups say.