A recent report by The AIDS Institute sounds the alarm on the growing rate of health insurance plans including a harmful policy known as co-pay accumulator adjustments that make it more challenging for people with life-threatening, chronic, and rare diseases to access their prescription medications.
The report found that two-thirds of health insurance plans available through the marketplace in 32 states include a co-pay accumulator adjustment policy. In 14 states, all available plans through the marketplace include one. Residents of those states who purchase marketplace insurance and have a serious or complex illness will not be able to use manufacturer coupons toward their deductibles, coinsurance, or other out-of-pocket costs.
Co-pay accumulator programs are creating financial stress and devastating trade-offs for people with serious illnesses to access their medications.Dan Klein, PAN Foundation President and CEO
“In situations where there are no generic alternatives, manufacturer coupons can be a lifeline to help pay for their deductibles, co-pays, and coinsurance. The PAN Foundation calls for an end to these harmful programs.”
Robin Lancaster, a PAN Foundation grant recipient from Kentucky with primary myelofibrosis, said that she was able to use co-pay cards from drug manufacturers to pay for her medications for years. When her husband’s company switched to a high-deductible insurance plan, they learned their new plan would not accept manufacturer co-pay assistance when Robin owed $10,000 at the pharmacy counter at her next refill, depleting their savings.
Only five states and Puerto Rico have enacted legislation that prohibits co-pay accumulator policies in marketplace plans, including Arizona, Georgia, Illinois, Virginia, and West Virginia.
About the PAN Foundation
The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.
Since 2004, we have provided nearly 1 million underinsured patients with $4 billion in financial assistance. Partnering with generous donors, healthcare providers and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.
Liz Eckert, Senior Director of Marketing and Communications
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