Patient Groups Sue Medicare Over Trump-Era Copay Assistance Rule (1)

Three patient advocacy groups are suing the Biden administration over a Trump-era rule that they argue has allowed insurers and pharmacy benefit managers to increase out-of-pocket prescription drug costs for consumers.

The complaint, obtained by Bloomberg Law, alleges the rule conflicts with the definition of “cost-sharing” in the Affordable Care Act and federal regulations. The rule (RIN: 0938-AT98) was issued in 2020 by the Centers for Medicare & Medicaid Services and says health insurers don’t have to count copay assistance from drugmakers toward a patient’s annual limitation on out-of-pocket costs.

The HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and ...