Patient groups sue HHS over copay assistance rule

A trio of patient advocacy groups is challenging a Trump-era rule that allows insurers to prevent financial assistance from drug companies from counting toward a patient’s annual out-of-pocket costs.

Insurers argue that drug companies’ copay assistance programs allow drug companies to steer patients toward expensive brand-name drugs, driving up health costs for everyone.

But in a lawsuit filed Tuesday in the U.S. District Court for the District of Columbia, the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council and the Diabetes Patient Advocacy Coalition argue that the rule disproportionately impacts people with chronic diseases, like diabetes and HIV, that require the use of costly drugs. The groups filed the suit against the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

The rule, which took effect in 2020, allows some insurers to implement so-called copay accumulator adjustment programs, and the groups argue that such programs effectively allow insurance companies to collect money from both patients and drugmakers without easing the financial burden on patients. 

“Patients are getting taken advantage of here,” said George Huntley, chief executive officer of the Diabetes Leadership Council. “Copay accumulator adjustment programs are, frankly, an evil money-grab by insurance plans and pharmacy benefit managers and are a blatant and we strongly believe illegal cost-shift back to patients.”