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Stop Copay Overpay Act
12/31/2022, 5:04 AM
Summary of Bill HR 4824
The bill aims to prohibit health insurance plans and pharmacy benefit managers from charging patients more in copayments for prescription drugs than the actual cost of the drug. This practice, known as copay clawbacks, has been criticized for unfairly burdening patients with higher costs than necessary.
If passed, the Stop Copay Overpay Act would require pharmacies to inform patients if the cost of their copayment is higher than the actual cost of the drug, and would allow patients to pay the lower amount. This would help to ensure that patients are not overcharged for their prescription medications. Overall, the Stop Copay Overpay Act seeks to protect consumers from excessive copayments and promote transparency in the pricing of prescription drugs. It is currently under review in Congress and has the potential to have a significant impact on the affordability of healthcare for many Americans.
Congressional Summary of HR 4824
Stop Copay Overpay Act
This bill prohibits the Department of Defense (DOD) from charging a covered individual (i.e., individuals enrolled under the TRICARE program) a co-payment exceeding a certain rate for an outpatient visit for mental health or behavioral health under the TRICARE program, regardless of whether the visit is furnished by a specialty care provider. Specifically, the co-payment amount may not exceed the amount of a co-payment that would be charged under the TRICARE program for an outpatient visit for primary care services.
During the one-year period after this bill is enacted, DOD may not increase the co-payment amount charged to a covered individual for any service (1) furnished by a specialty care provider under the TRICARE program, and (2) that is not mental or behavioral health care.
