Bass, Berry & Sims attorney Lindsey Fetzer outlined federal regulations governing the use of copay accumulator adjustments by health plans for an article examining the impact of copay accumulators on patients, pharmaceutical companies, health plans and government health programs. Some pharmaceutical manufacturers offer patient assistance programs that help patients cover their share of the cost of medications. Copay accumulators limit or exclude funds from these programs or other third-party sources from counting toward fulfilling a patient’s deductible.

In 2019, the Centers for Medicare & Medicaid Services (CMS) issued a rule allowing copay accumulators to be used for medicines that have a generic equivalent. After that rule was thought to conflict with other federal regulations, CMS issued a second, broader rule in 2020 that allowed insurers to implement copay accumulators as they saw fit, and Lindsey said, “economic incentives would suggest that they would.”

The full article, “War Over Drug-Cost Assistance Traps Sickest Patients in the Middle,” was published by Dow Jones MarketWatch on October 3 and is available online (subscription may be required).