What Are Copay Accumulators and How Are They Creating Medical Debt?
Thanks to Chronic Disease Coalition for sponsoring this post!
Have you heard of Copay accumulator programs? No?
Until recently, I hadn’t either. Copay accumulator programs aren’t well known because they mostly impact chronically ill patients on very expensive medication. This often includes people with autoimmune conditions and rare diseases. Most people don’t even know that these programs are part of their policy!
Copay accumulators legally allow health insurance companies to be paid TWICE for the same expensive medication.
How does this happen?
In order for patients to afford many expensive drugs, the drug company will provide a copay assistance card to cover the cost. This card is intended to prevent a patient from having to pay their full deductible and maximum out of pocket costs --often between $5,000 and $10,000 a year. With harmful copay accumulator programs an insurance company will take all the money from the copay assistance card, and then turn around and bill the patient for the full deductible and out of pocket costs anyway.
These programs cause bad outcomes for patients' finances and health. Picture walking up to the pharmacy counter to use your copay assistance card, being told that the card is maxed out and that you now have to pay your deductible to access your drug. Many patients are then forced to decide between paying for their drug or their mortgage, car payments, or higher education bills. And if they choose to stop taking the drug because it now costs too much, they are likely to become sick.
As if the financial impact of these programs wasn’t enough, the other problem is that people don’t know about them. Not only will they be responsible for thousands of dollars, but they also won’t be prepared for it! Many patients are clueless about all of this until they go to their doctor for treatment.
How does insurance get paid twice?
Insurance is paid once when you use financial assistance such as a copay assistance card
And the second time when the copay card runs out, and you’re left responsible for the entire deductible
Ridiculous right?! These programs are legal in 33 states! The Chronic Disease Coalition is working hard at advocating to make these programs illegal and every single voice counts! If we’re going to put an end to these programs, we have to speak up. Spread the word about the impact of these programs and encourage people to check their policies so they don’t get taken by surprise
To learn more and share your story, go to https://chronicdiseasecoalition.org/copay-accumulators/ .
