(NewsNation) — A court struck down a Trump-era rule that allowed insurance providers to exclude copay assistant programs from out-of-pocket costs, leaving patients paying higher costs while insurance providers pocketed money from drug company assistance programs.

Copay assistance programs are designed to help patients cover the costs of high-priced medications, like those used to treat diabetes, autoimmune disorders, cancer, HIV and other conditions. With drugs that can cost tens of thousands of dollars per dose, even patients with insurance can find themselves on the hook for copays that can run into the thousands each month.

In response to high copays for medications, many of which lack cheaper generic or biosimilar versions, pharmaceutical companies offer assistance programs to help patients afford medication. Copay programs vary widely between companies, with some offering one-time assistance and others offering ongoing help in varying amounts.

Under the Trump administration rule, insurance companies were allowed to use copay accumulators and prohibit copay assistance money from counting toward out-of-pocket maximums. Patients would then have to pay copays without any help until they hit that maximum amount, at which point the insurer would have to cover the medication in full.

For example, consider a patient whose copays totaled $12,000 per year with insurance, on a plan with an out-of-pocket maximum of $6,000 for prescriptions. If that patient qualified for a copay assistance program that provided $4,000 per year, that assistance contribution wouldn’t count toward their out-of-pocket costs, leaving them responsible for $6,000 of prescription costs. The insurer, however, would receive $10,000 from the combined payments.

Insurance companies argued that assistance money provided by pharmaceutical companies didn’t count as cost sharing since it wasn’t paid by patients. The plaintiffs, which included patient advocacy groups and three individual patients, argued that discounting assistance programs from cost-sharing allowed insurance companies to increase their profits while patients were burdened with extra costs.

In the decision, the judge ruled that the definition of cost-sharing included costs paid on behalf of patients as well as directly by patients, a definition that includes assistance programs. The decision means insurers will have to abide by a federal rule that governed 2020 plans which only allows copay accumulators to be used if a less expensive, generic version of a drug is available.

That means the hypothetical patient above would have that $4,000 in assistance funds credited toward their $6,000 out-of-pocket maximum, leaving them responsible for just $2,000 of copays before the insurance company had to cover the prescription in full with no copays.

“We are thrilled that the Court has taken the side of patients who have been struggling to afford their prescription drugs due to the greedy actions of insurers and their PBMs,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “We call on the Biden administration to immediately enforce this decision and not take any further steps to undermine the copay assistance that allows patients to access their essential medications.”