This session will discuss why, contrary to conventional wisdom, the need for co-pay and premium assistance, in this complicated environment, is likely to increase, not decrease, under the IRA. Panelists will explore the links between copays, adherence failures, and mortality and explain how public policy, including the OIG’s guidance on co-pay foundations, the accumulator rule, the FDA’s failure to address “alternative funding” programs involving the unlawful importation of unapproved drugs, the 340B program, and the IRA create devastating and interconnected barriers to patient access and health.