New policies are being put into place by many health plans called “copayment accumulator programs” or “accumulator adjustment programs.” Prior to these new policies, when a patient used a copay assistance card or other manufacturer assistance, the payment or discount credited by that manufacturer toward the cost of the treatment counted toward a patient’s deductible or out-of-pocket max.
The new copay accumulator programs target specialty drugs and are problematic for patients because they do not attribute manufacturer assistance for these medications to the patient’s deductible, increasing the amount a patient must pay on their own. Health plans save a significant amount of money by designing plans in this manner, because accumulator programs shift most drug costs to patients, while also driving patients towards cheaper drugs when they are available.
Robin Levy, IMF’s Senior Director of Public Policy and Advocacy stated “While those in favor of copay accumulator programs argue they could bring down drug costs in the long run, the sudden and unexpected rise in health care costs to patients is not an acceptable outcome. Many patients with chronic and rare diseases are vulnerable and depend on copayment assistance programs for their specialty medications.”
This new practice of copay accumulator adjustment, coupled with the rise of high deductible health plans (which are plans with deductibles of at least $1,350 for an individual), and coinsurance, makes it difficult, if not impossible, for patients to adhere to their treatment plans.
That is why, over the last year, Virginia, West Virginia, Arizona and Illinois became the first states to pass laws that ban copay accumulator programs. Similar bills have been offered in several other states, including Connecticut, Indiana, Kentucky and North Carolina. The IMF has been a part of this effort through our membership in various coalitions, and we will continue to provide the patient voice to legislators at the state and federal level in order to ensure continued access to doctor-prescribed treatments.
If you believe you or someone you know has been impacted by copayment accumulator programs, please contact the IMF Advocacy team at firstname.lastname@example.org