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.
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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.
Programs only allowed for brands with generic competition under court ruling, but related programs such as copay maximizers and so-called ‘alternative funding’ programs are not directly impacted by the decision.