SW Georgia News

U.S. Representative Buddy Carter (R-GA) recently announced that his advocacy led to the Biden administration's decision to abandon an appeal in the 2020 Notice of Benefit and Payment Parameters (NBPP) Final Rule. According to a statement from Carter's office, this development ensures the preservation of copay assistance for patients and reflects Carter's commitment to ensuring access to life-saving medications.

Carter was quoted by his office as saying, "Co-pay accumulator schemes allow insurers and pharmacy benefit managers (PBMs) to take away the assistance some patients rely on to access their life-saving medications. This is wrong and must end. I applaud the Biden administration for standing with patients by dropping its appeal and will continue working to ensure that this final rule is enforced. I look forward to working with my bipartisan colleagues to pass the HELP Copays Act, so that we can move closer to a health care system that puts patients before profits."

The case in question pertains to the Biden administration's decision not to pursue an appeal, thereby upholding the District of Columbia’s District Court ruling on the 2020 NBPP Final Rule. According to Carter's office, this ruling stipulates that copay assistance must count towards a patient’s deductible and annual limitation on cost-sharing in most instances. Carter collaborated with U.S. Representatives Barragán and Miller-Meeks, sponsors of the Help Ensure Lower Patient (HELP) Copays Act. Together, they advocated for the protection of patients' access to vital medications through numerous letters sent to the Biden administration since December 2023.

The bipartisan HELP Copays Act aims at curbing "copay accumulator" schemes used by health plans and PBMs, according to information from Carter's office. The legislation ensures that copay assistance counts toward a patient's deductible or out-of-pocket maximum. It also protects patients from unexpected high refill bills after copay assistance has been exhausted while preserving the original intent of copay assistance programs.