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Copay accumulator lawsuit aims to reduce costs to patients

The groups filing the lawsuit noted that 17 states and Puerto Rico have passed laws requiring insurance plans to count manufacturer copay assistance toward patients’ out-of-pocket obligations.

By Scott Wooldridge | May 25, 2023 at 01:15 PM
Insurance Card (Photo: Shutterstock)

A coalition of patient groups are taking the federal government to court over regulatory changes regarding “copay accumulators,” a complicated piece of the health care payment puzzle that could result in patients having much higher costs, if the changes stay in place. But some in the industry say the lawsuit is just one move in a much larger conflict between drug industry forces.

The patient groups argue that the copay accumulators that Pharmacy Benefit Managers (PBMs) use have the effect of sharply increasing the amount that patients pay. Industry insiders see the practice as an attempt by PBMs to indirectly shift costs, but as with other health care strategies, consumers can end up caught in the middle.

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