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CMS Final Rule Limits the Use of Copay Accumulator Programs by Insurers

Posted in Reimbursement Matters

On April 18,  the Centers for Medicare and Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters Rule for 2020 (Rule). This Rule is released annually to establish policies related to exchanges, as well as the broader individual, small group, and large group insurance markets in the US. See  Amongst its many provisions, the Rule finalized a policy that will allow health plans to implement co-pay accumulator programs (i.e., the disallowance of co-pay assistance, such as manufacturer coupons, from counting towards a person’s out-of-pocket maximum) if a generic alternative is available. CMS said the goal is to encourage patients to use generic drugs and lower drug spending.

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