Court Upholds Rejection of Pfizer Medicare Co-Pay Assistance

A Pfizer Inc. proposal to cover Medicare co-pay costs associated with a heart drug that costs $225,000 per year would likely violate the Anti-Kickback Statute, a federal court ruled.

Pfizer was challenging the Department of Health and Human Services’ rejection of the co-pay assistance program in a September 2020 advisory opinion.

The Department of Justice has recently been cracking down on drugmakers that have allegedly used charities and co-pay assistance programs to increase sales by removing cost barriers faced by patients. Settlements resulting from the enforcement drive have netted the government more than $1 billion.

The statute prohibits payments intended ...