States that ban copay accumulators full#
Patients with a high deductible, or a separate pharmacy deductible, could end up paying more over time because it will take them longer to meet their deductible and receive full insurance benefits. So, once a patient uses up any assistance, the patient is still responsible for their entire copay and maximum out-of-pocket expenses before their full insurance benefits kick in. The copay accumulator programs still allow patients to get assistance from the drug manufacturers or other groups, but they prohibit that assistance from being applied toward a patient’s deductible or annual maximum out-of-pocket expenses. However, in 2018, in response to the copay assistance programs, insurance companies and pharmacy benefit managers (PBMs) created copay accumulator programs. The assistance provided is capped at a maximum amount, and any contributions the assistance programs make to the cost of the medications can be applied to the patient’s deductible and out-of-pocket expenses until the maximum amount is reached. Manufacturers or charitable organizations can cover part of the cost of medications, relieving patients of some of the burden of meeting the cost of their copays and annual maximum out-of-pocket expenses. The programs are known as copay assistance programs, or sometimes coupon programs or copay savings programs. If it sounds confusing, that’s because it kind of is, but the simplest explanation is this: Pharmaceutical companies, and other organizations, often offer programs to offset the high cost of medications. The only catch is that there are now other programs in place that seem to negate any of the benefits that the assistance programs provide. Assistance is often provided by charities, nonprofits, or drug manufacturers, and is designed to offset the cost of treatments and medications. Prescription medications can be super expensive so, it’s a good thing that there are assistance programs available to help patients cover some of the costs.
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