WLF Post Looks at Pfizer’s Copay Subsidy Program

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Last month, the U.S. Court of Appeals for the Second Circuit affirmed a lower court’s decision that a Pfizer-planned copay subsidy program for Tafamidis, indicated for treating a rare heart condition, violated the anti-kickback statute. The program would have offered financial assistance to qualifying patients (including Medicare beneficiaries).

Writing in an online Washington Legal Foundation online post, Goodwin Procter partner Matt Wetzel notes that Pfizer earlier sought an advisory opinion from the HHS Office of Inspector General (OIG) as to whether the program would violate the anti-kickback statute, and the OIG responded unfavorably.

Wetzel’s post offers guidance on understanding OIG’s position and how drug companies can find important direction for “how to establish internal controls that pass muster under OIG’s standards.”

Wetzel contends that pharmaceutical manufacturers still have options to help financially needy patients despite the recent court ruling. “That support,” he cautions, “needs to be mindful of Medicare rules (not to mention rules that commercial payors and health plans might also have with respect to copay and cost-sharing support) and should be coupled with well-defined internal controls.”

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