The CMS final rule on drug reimbursement addresses how co-pay coupons and vouchers are being exempted from deductibles by PBMs. The rule seems to ensure that the full value of manufacturers’ coupon and voucher programs accrue to the enrolled patient, meaning that the portion of the cost of the drug paid by the manufacturer program counts toward a patient’s deductible and not be exempted from it, as happens when a PBM (or payer) implements an accumulator program.
While the intent of the final rule seems to help the patient, CMS makes the manufacturer responsible for determining whether a PBM has implemented an accumulator program, which is difficult (if not impossible) to discern and track.
During a 60-minute webinar at CBI’s annual Patient Assistance and Access Programs conference, Kevin O’Meara, Vice President, Patient Services Solutions, and Brian Abraham, Director of Revenue Management Solutions, outline how co-pay accumulator and maximizer programs will be impacted by new regulations.
Watch the recording:
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