Insurance discrimination spreads to copay accumulator programs

11.2.18

Insurance companies always seem to be looking for new ways to make it harder for patients to receive the care and treatment they need. Many patients, doctors, pharmacists and other medical professionals are forced to work within or around the system, coming up with new and creative ways to access timely, affordable treatment so people can manage chronic diseases.

For many patients, copay assistance programs provide crucial financial aid allowing them to obtain the medication they need to manage their condition. Charities and nonprofits, as well as drug manufacturers, offer this assistance to patients who cannot afford their treatment, even if they have health insurance. Oftentimes, insurance companies will not cover the medication prescribed by the doctor or only cover a portion of the cost, leaving patients to pay thousands of dollars a month in medical bills. Copay assistance programs help to ease the financial stress burdening patients and prevent them from making tough financial decisions like choosing to pay for the medication or other necessities, like food and rent.

Historically, receiving copay assistance would count towards a patient’s deductible or out-of-pocket maximum, furthering its helpful impact on patients. However, insurers have begun to fight back and copay accumulators, or accumulator adjustment programs, are beginning to surface. Copay accumulator programs prevent manufacturer or charitable copayment cards from being counted towards a patient’s deductible or out-of-pocket maximum. Charities and manufacturers who sponsor copayment programs say that these programs help patients try cheaper medications.

Not only does copay assistance help low-income chronic patients afford their medication, it also helps rare disease patients pay for costly medication. Without copay assistance, patients like Adam Meyer, who suffers from Gaucher’s disease, would have to pay $1 million annually for lifesaving medication.

According to the National Business Group on Health, 17 percent of employers are using copay accumulators, and that number is expected to rise to 29 percent in 2019. In response, organizations like the Federal AIDS Policy Partnership and the Human Rights Campaign have called on insurance commissioners to investigate copay accumulator programs, given these harmful measures could prevent patients from accessing lifesaving medication.

The Chronic Disease Coalition opposes copay accumulator programs and believes patients should have access to affordable and effective treatment, regardless of their disease and financial status.