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.”
Please let us know if this is an issue that is affecting you.
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