Patient Advocacy Groups Embroiled in Copay Suit with PBMs

A rule from the Centers of Medicare and Medicaid Services (CMS) allows pharmacy benefit managers (PBMs) to ignore copay assistance programs from drug manufacturers when accounting for out-of-pocket drug costs for patients. Patient advocacy groups have filed suit against CMS to contest this rule from the Trump Administration.

According to Celene Castronuovo, “The HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed their lawsuit in August, alleging that the 2020 CMS rule conflicts with the definition of “cost-sharing” in the Affordable Care Act and federal regulations. Several groups have since filed amicus briefs in support of the challenge, including leading drug industry trade group the Pharmaceutical Research and Manufacturers of America and a coalition of 29 patient, provider, and consumer organizations.”

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(Source: Bloomberg Law, March 6^th, 2023)