The administration of Donald Trump is facing criticism after the proposed 2027 Notice of Benefit and Payment Parameters (NBPP) rule omitted key reforms aimed at reducing prescription drug costs for patients.
Advocates argue that the proposal fails to clarify whether manufacturer copay assistance must count towards a patient’s deductible and other cost-sharing limits. The issue has long been contentious, particularly over the use of “copay accumulator” programmes by insurers and pharmacy benefit managers (PBMs).
Copay assistance loophole under scrutiny
Under copay accumulator policies, financial support provided by drug manufacturers does not count towards a patient’s annual out-of-pocket maximum. Critics say this enables insurers and PBMs to retain billions of dollars intended to ease patients’ financial burden.
Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, warned that delays in closing this regulatory gap allow insurers to continue benefiting at patients’ expense. Although the government previously addressed similar concerns in earlier NBPP rules, enforcement has reportedly been deferred pending updated regulations.
Rising out-of-pocket limits add pressure
The financial implications are significant. The annual maximum out-of-pocket limit for 2027 is set to rise by 13 per cent to 12,000 US dollars for individuals and 24,000 US dollars for families.
According to industry data, drug manufacturers provided 21.4 billion US dollars in copay assistance in 2024. Of that, insurers and PBMs retained nearly 7 billion US dollars, roughly 37 per cent of the total.
Advocates say the absence of clearer rules in the 2027 proposal leaves patients uncertain and financially vulnerable. They are urging swift regulatory action to ensure that assistance meant for patients directly reduces their healthcare expenses rather than being absorbed within insurance structures.
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