Скачать или смотреть Employer Prescription Benefits Toolkit: Copay Accumulators

This video features the story of Jen and Penny Hepworth, a mother and daughter who suffer from ankylosing spondylitis and cystic fibrosis, respectively. Jen was shocked when after years of having their financial assistance count toward their family deductible and out-of-pocket maximum their insurance company changed the rules, requiring them to pay those amounts a second time. Learn more about Copay Accumulators in The Employers’ Prescription for Employee Protection Toolkit: Best Practices for Prescription Drug Benefit Design at https://www.cancercare.org/betterrxbe...

Copay accumulator programs take effect when a patient receives financial assistance to help cover their copayment for a prescription drug, which may be in the form of a coupon from the drug manufacturer or help from a copay foundation or other charity. Financial assistance is generally used by patients accessing very expensive specialty drugs that treat things like cancer, hemophilia, HIV, and cystic fibrosis.

The copay assistance is paid to the insurance company on behalf of the patient, and until recently, was counted toward the patient’s annual deductible and out-of-pocket cap. But under a copay accumulator program, insurance companies don’t count these third-party payments toward the patient’s deductibles and out-of-pocket caps, making it more difficult for patients to afford their treatments.

Copay accumulator programs have many names, and most patients don’t know they are part of their insurance plan until they reach the point where believe they’ve fulfilled their deductible or out-of-pocket cap and are told that, no matter how many thousands of dollars have been paid on their behalf, they must pay their deductible and out-of-pocket cap a second time from their own funds – an obligation that many patients cannot afford. There’s no getting around the fact copay accumulator programs allow insurers and pharmacy benefit managers (PBMs) to double-dip – getting paid twice for the same benefits.

PBMs claim that patients using copay assistance will end up taking more expensive drugs, but this simply isn’t true. Patients can only use copay assistance for drugs that their insurance company has already approved, which means that even the insurer agrees it’s the right drug.