On September 29, 2023, the United States District Court for the District of Columbia held that the Patient Protection and Affordable Care Act 2021 Notice of Benefit and Payment Parameters (NBPP), which permitted the use of co-pay accumulators, must be set aside due to its contradictory reading of the same statutory and regulatory language and because the Department of Health and Human Services (HHS) has yet to offer a definitive interpretation of this language to support the rule. The Court remanded the matter to HHS to decide whether manufacturer co-pay assistance is part of the statutory definition of cost-sharing.