Today the National Organization for Rare Disorders – NORD – issued a statement and provided a very useful explanation regarding the increasing use of copay accumulator programs in health plans. The NORD statement reads in part:
“Recently, a number of health plans have started implementing, what are broadly known as, ‘copay accumulator programs.’ These programs prevent manufacturer-provided copay assistance from applying to patients’ out-of-pocket costs, including their insurance deductible. As a result, copay accumulator programs drastically increase the amount of money patients pay over the course of a year to acquire their prescribed medications … read the complete statement here. NORD also provided a very helpful guide and explanation of the issue with copay cards and the problems this can create for patients and their families (view the complete document here).
In February of this year, we published under our Briefings heading a note about insurance company rumblings limiting the use of drug copays that previously counted against deductibles. Jill Sisco, who is a PWN contributor and president of Acromegaly Community, a leading patient support, and advocacy group brought this issue to our attention with a letter a patient had received regarding this troublesome issue.
This is a paragraph from an insurance company letter received by this patient and published by PWN on February 10, 2018:
“The availability and use of drug co-pay cards from drug manufacturers have become increasingly popular, especially with high-cost specialty medications. The use of these cards, in addition to your pharmacy benefit identification card, can reduce your out-of-pocket costs. However, they also impact your responsibility in meeting deductible and out of pocket calculations with your own dollars. We are not limiting the use of these drug copay cards in the specialty pharmacy but drug copay card dollars WILL NOT be included in your deductible and out of pocket maximum (member share). Only your true out of pocket costs will be applied to your deductible and out of pocket accumulated benefit totals.”
You can read the PWN article here.
Please let us know if this is an issue that is affecting you.
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I’m dealing with this problem now. I have Acromegaly and take Somatuline Depot every month to control it. I have a high deductible insurance plan with a $3,500 deductible and $2,500 out of pocket max. My shot is $7,500 a month. I’ve been using a copay assistance program to help pay for my out of pocket expenses. Without that assistance, I would need $6,000 to buy my first shot in January. I dont know too many people who have an extra 6 grand laying around to buy one shot. Since my insurance wont apply that money to my Out of pocket expenses, my assistance funds will run out in March. So when April comes, I’ll need to have $6,000 or i wont be able to get my medication. I’ve already told my Dr that i wont be able to get my regular lab work done either. That was the bonus of hitting my deductible early, that i could go get all the testing i needed to stay healthy, without worrying if i could afford it. In Ohio and there is a Bill in legislation, H.B.469, to prohibit this practice by insurance companies. I submitted testimony in support of the bill. I can only hope they pass it and it goes into effect prior to April. However, this is not likely & I’m not going to hold my breath. Everyone needs to reach out to their government representatives and help bring this practice to an end.