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Current Issue: Accumulators
OUR CURRENT FOCUS:
Copay Accumulator
Adjustment Programs
North Carolinians are facing more out-of-pocket costs. Recently, insurers and PBMs have implemented “copay accumulator adjustment programs." These policies prevent any copay assistance (whether it be from charities, copay cards, churches or other third-parties) from counting towards a patient's deductible or out-of-pocket maximum. So copay assistance no longer reduces a patient or a family's cost-sharing burden.
Such copay accumulator adjustment programs are a growing problem. In fact, a new report by The AIDS Institute shows that five out of six 2021 Marketplace plans in North Carolina have implemented them.
The Impact
Why do people need copay assistance?
Many patients living with chronic or complex conditions — from arthritis to cancer, hemophilia, epilepsy, diabetes and more — rely on copay assistance from nonprofits, charities, manufacturers and other third-parties help afford the cost of health insurance copays, which can be extremely expensive. Traditionally, this copay assistance has counted toward an individual or family's health insurance deductible or out-of-pocket maximum to lessen the cost.
Let's ask North Carolina
lawmakers to help.
A growing number of states (including Tennessee, Kentucky, Georgia and Virginia ) have recently passed legislation prohibiting or limiting the use of copay accumulator adjustment programs.
North Carolina can also act by making sure that health insurers count all payments made by, or on behalf of, patients towards their deductibles and out-of-pocket maximums.
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Fair Health North Carolina is a project of the state's leading patient and provider organizations.
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