Whilst On The Topic Of US Pricing / Out Of Pocket Drug Co-Pays...

There could certainly be a lively, full-time blog devoted just to covering the litigation to-and-fro -- and the insanity that makes up the crazy quilt of US laws, rules and sharp (pharma, PBM and insurer) practices. . . which decide how much a given individual US consumer (with or without health insurance) has to pay out of pocket -- for any of his or her life saving medicines.

During the Trump administration, GOP legislators, GOP agency leaders and Tangerine (despite talking about reducing drug prices) worked together to institute new CMS rules that allowed PBMs and pharmacies and insurers to require that patients "accumulate their co-pays" before the benefits of capped out of pockets would kick in. This effectively greatly increased the amount individuals, many on very limited incomes, with life-long medication needs. . . actually paid from 2018 to 2021.

And since my post of this morning paints pharma as having been treated unfairly, under 340B -- I will mention this FierceHealthcare countervailing item, from about two weeks ago, now. "Regrettably, the federal agencies charged with implementing the ACA have endorsed the efforts of large insurers and pharmacy benefit managers to impede access to innovative medicine by denying patients the benefit of contributions provided by drug manufacturers when calculating patient payment obligations. . . "

And so, in DC, a federal lawsuit is challenging this bit of ledger-domain rammed through by the PhRMA lobbyists, under a pliant GOP Senate and House in the early part of the former guy's time. Here's the full federal complaint at law, and a bit from Fierce:

. . .A collection of patient advocacy groups is suing to demand the federal government outlaw copay accumulator programs they say inflate healthcare costs.

The three groups filed the lawsuit Tuesday in the U.S. District Court for the District of Columbia challenging the legality of a Trump-era rule that allows insurers to avoid counting the value of drugmaker coupons toward patient out-of-pocket costs and deductibles. . . .

Now you know. Be excellent to one another, on this fine weekend of late summer.


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