Proposed Rule Reignites Fight Over Copay Accumulators

Health insurers are praising a provision in a recently proposed regulation that gives commercial plans greater leeway to run so-called copay accumulator programs, which prevent drug manufacturer coupons from counting toward patients’ annual deductibles or out-of-pocket cost limits. But the pharmaceutical industry slammed the proposal as “misguided” and liable to prevent patients from getting vital medications.

Regardless of whether CMS finalizes the copay accumulator provision in the proposed 2021 Notice of Benefit and Payment Parameters (NBPP) — an omnibus rule that primarily lays out regulations for Affordable Care Act-compliant plans — one health policy expert says such programs are a trend that will stick around as insurers look to lower the amount they spend on prescription drugs.

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• Radar on Drug Benefits