The Patient Access Network (PAN) Foundation commended CMS' decision to ban the use of co-pay accumulator programs when no generic alternatives are available, calling it a significant win for patients who rely on specialty medications with high out-of-pocket costs. The rule allows drug manufacturer coupons for brand name medications to count toward the patient's deductible and annual out-of-pocket cost limit when no generic is available.
According to PAN, while not a total prohibition of these programs, it is an important move to ensure economically vulnerbale patients have access to life-saving specialty medications, many of which do not have generic alternatives.
“Co-pay accumulator programs lead to greater out-of-pocket costs for individuals with life-threatening, chronic and rare diseases,” said Dan Klein, PAN’s president and chief executive officer.. “In situations where there are no generic alternatives, many patients need manufacturer coupons to help pay for their deductibles, co-pays and coinsurance. Otherwise, these patients would be unable to obtain their critical medications without having to make devastating financial trade-offs.”