Patients Caught in Drug Industry, PBM Battle on Copay Assistance

High drug costs will linger for patients whatever the outcome of the latest battle between the pharmaceutical industry and health plans over drugmaker copay assistance programs, analysts say.

A lawsuit from drug industry-backed patient advocacy groups is challenging a Trump-era rule (RIN 0938-AT98) from the Centers for Medicare & Medicaid Services. The rule says pharmacy benefit managers—the entities that manage prescription drug benefits on behalf of insurers— don’t have to count drugmaker copay assistance toward patients’ out-of-pocket costs.

The patient groups say the rule allows PBMs to accept the drugmakers’ copays on behalf of patients while doing nothing to lower ...