Court Strikes Down Rule to Protect Consumers from High Drug Prescription Costs

By Consumers for Quality Care, on October 25, 2023

A federal judge overturned a rule that previously allowed health insurers to exclude copay assistance from counting toward a patient’s cost-sharing requirements, a tactic that often raises prescription drug costs for consumers, Fierce Healthcare reports.

The ruling, handed down by Judge John D. Bates in the U.S. District Court for the District of Columbia, will now only permit insurers to use copay accumulators for brand-name drugs that have generic equivalents.

The patient advocacy groups that filed the lawsuit applauded the decision. They believed that the old rule benefitted health insurers and the pharmacy benefit managers (PBMs), rather than consumers. “We are thrilled that the Court has taken the side of patients who have been struggling to afford their prescription drugs due to the greedy actions of insurers and their PBMs,” said Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute, one of the three advocacy groups that filed the lawsuit.

These groups are now urging the Biden administration and states to enforce the ruling and to prevent further undermining of copay assistance.

CQC urges lawmakers and regulators to protect consumers from predatory practices in the health insurance and PBM industries.