Copay accumulator policies are usually found in an insurer’s plan documents, such as an Evidence of Coverage, Certificate of Coverage, or Summary of Benefits document. But they aren’t easy to find, and are often confusing.
Examples of copay accumulator policy language:
- The following amounts may not be used to satisfy the Benefit Period Deductible:
- Discounts, coupons, or other amounts from third parties, including manufacturer coupons and discount prescription card programs
- Please note, cost-sharing reduction for any prescription drugs obtained by You through the use of a discount card or coupon provided by a prescription drug manufacturer will not apply toward any Deductible, or the Annual Out-of- Pocket maximum under Your Plan.
- Some specialty medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products, subject to prior approval. For any such specialty medication where third-party copayment assistance is used, You will not receive credit toward Your maximum Out-of-Pocket or Deductible for any Copayment or Coinsurance amounts that are applied to a manufacturer coupon or rebate.