Copay Accumulator Ban Explained

A copay accumulator ban is a policy that prohibits health insurance companies from using a practice called copay accumulator adjustment. This means that the insurance company can't count the amount you pay out of pocket for a prescription towards your deductible.

Copay accumulator adjustment was a sneaky tactic used by insurance companies to increase their profits. By not counting the copay towards the deductible, the insurance company could force patients to pay more for their medications. This was especially unfair for patients who were already struggling to afford their prescriptions.

In 2022, several states began to ban copay accumulator adjustment, and more are expected to follow. This is a huge win for patients who rely on their medications to manage chronic conditions.

As of November 2023, 19 states, the District of Columbia, and Puerto Rico have passed legislation requiring insurers to count copay assistance paid on behalf of patients toward their deductibles.

The Association for Clinical Oncology (ASCO) strongly opposes copay accumulator programs, which can leave patients with high out-of-pocket costs at the end of their plan year.

ASCO is a member of the All Copays Count Coalition, a group of over 80 patient and provider organizations leading the effort to ban copay accumulator programs at both the federal and state levels.

Four states had bills pass one chamber of their legislature for the first time in 2023, bringing the total number of states actively working on copay accumulator legislation to 23.

California, Florida, Iowa, Michigan, Missouri, North Dakota, Pennsylvania, Wisconsin, and Utah are expected to introduce and possibly act on copay accumulator legislation in 2024.

For patients with complex, chronic conditions, copay assistance is vital.

It offers them access to their necessary medical therapies at a reasonable rate.

Cost of care skyrockets when copay assistance is excluded as an out-of-pocket expense.

Patients are then left to choose between enduring outrageously high medical costs or discontinuing their successful treatment, leading to adverse health effects.

These programs are a lifeline for patients who rely on them to afford their medication.

The copay accumulator ban is a game-changer for patients with chronic conditions. It's a rule that prohibits health insurers from using copay accumulator programs, which can leave patients with thousands of dollars in unpaid medical bills.

Patients with chronic conditions, such as diabetes, are often forced to pay out-of-pocket for their medications due to high copays. This can lead to financial ruin, especially for those on a fixed income.

The ban aims to protect patients from these unfair practices and ensure they receive the care they need without facing financial hardship. Insurers must now pass on any discounts or rebates they receive from pharmaceutical companies to patients, not just keep them as profits.

The ban applies to all health insurers, including Medicare Advantage plans, which often use copay accumulator programs to save money. This means patients on Medicare Advantage plans will also benefit from the ban.

The ban is a significant step towards making healthcare more affordable and accessible for all patients. It's a victory for patients and advocates who have been fighting against these unfair practices for years.