Court strikes down Trump-era rule that allowed health insurers to broadly use copay accumulators

A U.S. judge has struck down a Trump administration rule that allowed health insurers not to count copay assistance offered by drug companies toward out-of-pocket costs, a victory for advocacy groups that argued the rule harmed patient health.

At issue is the complex and often opaque health insurance system in the U.S., which has prompted long-running battles between drugmakers and insurers over the cost of prescription medicines. In this instance, the focus of the case was on a wonky, but significant tool called copay accumulators, which are used by health plans to blunt the cost of medicines prescribed to their beneficiaries.

The story begins with copay assistance programs, which drugmakers have offered for years to help patients afford medicines by mitigating out-of-pocket and deductible costs. Health plans counter that such assistance — generally, in the form of copay coupons or cards — is just a marketing tool used to direct consumers to higher-priced drugs, which eventually raise costs to the entire health care system.

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