Prohibit co-pay accumulators

PAN’s POSITION

Co-pay accumulators or similar programs lead to greater out-of-pocket costs for individuals with life-threatening, chronic and rare diseases and should be prohibited. 

Congress and the Centers for Medicare and Medicaid Services (CMS) should prohibit harmful co-pay accumulator programs and require health insurance plans to apply financial assistance received on behalf of a patient toward their out-of-pocket maximum.

Why co-pay accumulators should be prohibited

With high-deductible health plans on the rise, patients with serious conditions often turn to financial assistance to afford their out-of-pocket prescription medication costs in a variety of ways. They might seek help from charitable assistance foundations, manufacturer assistance programs, friends and family, faith-based communities, and even crowdfunding sites. These forms of assistance are a lifeline for people who need ongoing access to expensive specialty drugs required to treat their conditions.  

Commercial insurance co-pay accumulator policies prevent patients from using financial assistance to count toward their deductibles, resulting in a much larger overall out-of-pocket financial burden. These policies are especially harmful to lower-income patients who require expensive medications and those enrolled in high-deductible health plans. 

For years, I was able to use patient assistance to help meet the increasing out of pocket responsibility before accessing my medications. It was shocking to have a $10,000 surprise in January. It had taken us years to build our savings and then it was gone.

– Robin Lancaster, living with primary myelofibrosis