PhRMA Suit Challenges Co-Pay/Accumulator Portion of December 2020 Medicaid Rule -

On May 21, 2021, Pharmaceutical Research and Manufacturers of America (PhRMA) filed suit in the US District Court for the District of Columbia, challenging the portions of the December 2020 Medicaid final rule related to the price reporting treatment of manufacturer-sponsored patient co-pay assistance programs when the patient’s health plan has implemented a so-called “accumulator adjustment program.” PhRMA explains that the final rule “treats financial assistance manufacturers provide to patients as if such assistance were a price discount that the manufacturer instead provided to the patients’ health plans, unless the manufacturer somehow ‘ensures’ that no health plan retroactively takes the benefits that the manufacturer intended for and provided to patients through the imposition of an accumulator adjustment program,” which PhRMA asserts “contradicts the Medicaid rebate statute’s plain text.” The case is Pharmaceutical Research and Manufacturers of America v. Becerra, No. 1:21-cv-01395 (D.D.C. filed May 21, 2021).