Copay Maximizers May Be Restricted In Small Private Plans Under CMS Proposal: Will Broader Impact Follow?

 
• By Cathy Kelly
  
Generate a summary of this article
Listen to this article
Beta

The Centers for Medicare and Medicaid Services requests stakeholder feedback on how extensively copay maximizers are being used by insurers, which could help pave the way for restrictions on large employer and self-insured plans. 

Copay Maximizers, Accumulators And Alternative Funding Programs Aim To Counter Or Exploit Manufacturer Assistance • Source: Shutterstock

The Centers for Medicare and Medicaid Services is proposing to formalize its policy against private insurance plans designating some covered drugs as “non-essential health benefits,” which could limit the use of copay maximizer programs.

Key Takeaways

  • CMS 'codifies' policy barring individual and small group plans from designating covered drugs as 'non-EHB' and not subject to annual limits on cost sharing.

The proposal is part of the CMS Notice of Benefit and Payment Parameters for 2025 proposed rule released on...

Pink Sheet Podcast

Learn what's happening at the US FDA. On the go.

Derrick Gingery and the team bring you a weekly "Drug Fix".

SpotifyApple PodcastsWebsite

More from Archive

Final Chance To Have Your Say: Take Our Reader Survey This Week

 
• By Nielsen Hobbs

This is your final call to participate in the survey to better understand our subscribers’ content and delivery needs. The deadline is 20 September.

Test H1 Heading

Test H1 Story

Shape Our Content: Take The Reader Survey

 
• By Nielsen Hobbs

We are conducting a survey to better understand our subscribers’ content and delivery needs. If there are any changes you’d like to see in coverage topics, article format, or the method in which you access the Pink Sheet – or if you love it how it is – now is the time to have your voice heard.

More from Pink Sheet

COVID Vaccines: US FDA Changes Course, Wants New Formulas To Target KP.2 Subvariant ‘If Feasible’

 
• By Sue Sutter

Revised recommendation is based on most recent data on circulating strains in US, where KP.3 is now dominant. Novavax sticks with plans targeting the JN.1 ‘parent strain.’

Nancy Tests New Podcast Template

 
• By Derrick Gingery

Pink Sheet reporter and editors discuss the US FDA’s changes to the COVID-19 vaccine indication and its revocation of the vaccine emergency use authorizations, as well as new vaccine coverage and reimbursement questions.

PinkSheet-R&D-Free: ‘Ranking’ article that includes different Composer content

 
• By Nabil, Olga Zviezdicheva, Reed Miller, Mary Jo Laffler, Ian Schofield, João Andrés-Ruíz de la Fontaine-LeBlanc, Chloë Anastasía-Stojanović del Castillo-Ribeirão, and Nabil

To make your document look professionally produced, Word provides header, footer, cover page, and text box designs that complement each other. For example, you can add a matching cover page, header, and sidebar. Click Insert and then choose the elements you want from the different galleries.