Major Victory for DLC on Behalf of Patients

In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs.

The case was brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three patients who depend on copay assistance and whose insurers implemented “copay accumulator” policies.

By using “copay accumulators,” health insurers pocket the copay assistance patients receive, rather than allowing it to assist patients in paying for their necessary medication.

Insurers will now have to abide by the federal rule that governed the 2020 health plans. Under this, copay accumulators are permissible only for branded drugs that have a generic equivalent, if allowed by state law. Now, insurers are precluded by federal regulation from implementing copay accumulators for drugs that lack generic equivalents.