Patient Impact

COPAY ACCUMULATORS HARM PATIENTS

Patients are being harmed by copay accumulator adjustment policies (CAAPs) that bar copay assistance from counting towards a patient’s deductible or out-of-pocket maximum. These policies take away support intended for patients and harm them by:

Exposing vulnerable patients to large, unexpected costs: CAAPs disproportionately impact patients suffering from serious illness, particularly those who are low income or persons of color.
Interrupting necessary treatment: Nearly all copay assistance is used to pay for medicines without generic alternatives. When more costs are transferred to the sick and vulnerable, those patients often lose access to needed medications—driving down drug adherence and resulting in other more costly health issues. CAAPs create an unnecessary barrier that interrupts the course of critical treatment for patients.
Undermining patient protections: The Affordable Care Act provided minimum standards for coverage and protections against high out-of-pocket costs, particularly for those with pre-existing health conditions. CAAPs erode these protections and harm patients with serious chronic health conditions.

Insurers can continue to charge patients as if they have not been paid, driving higher profits, while patients go without necessary medications. This practice is so egregious that the Federal Employees Health Benefit Plan announced earlier this year that it would not accept any plan that employs it.

PATIENTS AND ADVOCATES SPEAK OUT

Learn more about the harmful impact of copay accumulators adjustment policies from patients with various health conditions, caregivers and patient groups working to help protect them:

Jim Turk | A Multiple Sclerosis Patient
“Copay accumulator programs can be devastating to MS patients and those battling other conditions who could very well lose access to the drugs they rely on to maintain their health and well-being…”

Richard Pezzillo | Executive Director of the New England Hemophilia Association
“Health plans claim that accumulators are needed to prevent third-party assistance from artificially inflating drug prices…However, this argument makes no sense for those with hemophilia or the many other conditions where no generic alternative is available….”

Jen Hepworth | Mother of Cystic Fibrosis Patient
“For my family, not having this critical assistance count toward our deductible could result in us losing access to a drug that keeps my daughter alive and thriving.”

Melissa El Menaouar | A Patient with Primary Biliary Cholangitis
“When the assistance runs out, patients are still at square one with their insurance company and are faced with significant out-of-pocket costs for their medication. Often, it’s enough to make a patient walk away and stop taking their prescription.”

Tami Seretti | Co-chair of the National Psoriasis Foundation Eastern Advocacy Committee
“For people like me who rely on copay assistance to pay for medications, copay accumulator adjustment programs make it nearly impossible to afford the out-of-pocket costs.”