Thank you to Chronic Disease Coalition for sponsoring this post!

Medically complex or chronically ill patients often need expensive and specialized medications and treatments to manage their symptoms and disease. A lot of these medications do not have a generic, so the costs are very high. In order to afford their treatments, many patients utilize copay assistance.

Copay assistance is incredibly helpful for patients except for when their insurance plan has a copay accumulator program. Copay accumulator programs are rampant in the United States. Insurance companies implement them in order to increase their revenue.

What happens is insurance companies will accept copay assistance on behalf of a patient for expensive medications, but do not apply the cost of the medication to the patient’s deductible - they only apply the amount the patient paid. 

When the copay assistance runs out, patients are often confused when they’re responsible for the rest of their deductibles and out of pocket maximums. In many cases, this can be up to thousands of dollars.

Patients are stuck deciding between medications and rent, tuition, or mortgages while insurance companies are essentially getting paid twice.

This is an unfair burden to patients, and these programs shouldn’t be legal. Unfortunately, most patients don’t even know these programs are part of their policy! This is why awareness is so important.

Copay Accumulator Program Facts:

• Washington, DC and 33 states have insurers that have sold plans with an accumulator program in 2020

• Approximately 60% of patients are enrolled in commercial health plans that can implement a copay accumulator program

• Nearly 70% of patients abandon treatment when the cost exceeds $250

• 84% of silver plans in the marketplace use a specialty drug tier

Are you ready to take some action?

The best thing you can do is check your policy so you can be prepared, and spread the word about the impact of these programs! We all need to speak up in order to make these programs illegal in all 50 states.

Have you been affected by a copay accumulator program?

Chronic Disease Coalition would love for you to share your story athttps://chronicdiseasecoalition.org/copay-accumulators/ .