Punishing patients who rely on drugs without generic alternatives is not fair. However, 99.6% of copay assistance is used for branded drugs without a generic alternative. Insurance providers argue that copay assistance leads patients to choose brand name drugs over generic equivalents, leading to higher overall prescription costs.
States that ban copay accumulators full#
They limit copay assistance to staving off the high costs of medications in the short term, but once the limit for the copay assistance program has been reached, individuals then must pay their full deductible or out-of-pocket maximum before their insurance benefits cover medication costs. How do copay accumulators affect prescription costs?Ĭopay accumulator programs eliminate the long-term benefit of copay assistance to patients. Unfortunately, over the past several years, IDF has seen a rise in the prevalence of insurance copay accumulator programs, which do not allow copay assistance to count toward deductibles or out-of-pocket maximums. The amount covered by copay assistance is intended to be counted toward an individual’s insurance deductible or out-of-pocket maximum, decreasing the amount of money an individual spends out of pocket before their insurance benefits kick in. Typically, individuals that qualify for copay assistance are the most financially vulnerable patients. These programs are offered by charities, nonprofits, and manufacturers of specialty medications to offset the out-of-pocket medication costs for qualifying patients. To help temper high prescription costs, many individuals living with chronic disorders, including primary immunodeficiencies (PI) or inborn errors of immunity (IEI), receive copay assistance.
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