John S. Linehan, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore and Washington, DC, offices, was featured on Managed Healthcare Executive’s podcast – MHE Talks: Improving Patient Access – in “Health Plans, PBMs Must Disclose Their Accumulators, Maximizer Programs for New Transparency Rules,” with Peter Wehrwein and Briana Contreras.
Following is an excerpt:
This interview accompanies Linehan’s article “New state copay accumulators complicate the coupon compliance landscape,” which was posted on the MHE website recently. In the interview, Linehan surveys some of the recent legal developments that would affect the administration of the copay accumulators and maximizers that health plans and PBMs use to blunt the effect of drug manufacturer coupon programs.
Linehan, a legal [advisor] on the coupon accumulators and maximizers, says new transparency rules for health plans issued by CMS in October include a provision that, effectively, requires health plans and PBMs to disclose to their beneficiaries that they are using accumulators or maximizers.
Most large, sophisticated plans and PBMs already do, according to Linehan. Still, he said he sees the new rule as a significant step: “It does create, for the first time, a bright-line disclosure rule.”
“New plans, smaller plans, employer groups and so forth that are starting to use these mechanisms (accumulators and maximizers) should be on notice that they need to properly disclose that they are using these programs,” Linehan continued.
Linehan also sketched the federal government’s role in regulating accumulators and maximizers. …
See Mr. Linehan’s recent article “New State Copay Accumulator Laws Complicate the Coupon Compliance Landscape” and his two-part video interview: “New Transparency Rules Mean Health Plans, PBMs Must Disclose Their Accumulators, Maximizer Programs” and “Accumulator, Maximizer Regulation Picks up at the State Level.”