The PAN Foundation applauds the introduction of the bipartisan Help Ensure Lower Patient Copays Act in the U.S. House of Representatives by Reps. Donald McEachin (D-VA) and Rodney Davis (R-IL). This act would permanently ban co-pay accumulator programs in employer-sponsored and Affordable Care Act marketplace health insurance plans.
Implemented by health insurance companies, co-pay accumulator programs prevent patients enrolled in the plan from using financial assistance from drug manufacturers to count toward their annual deductibles and out-of-pocket drug costs, resulting in a substantial financial burden for their medications.
“Co-pay accumulator programs require people who are seriously ill and economically vulnerable to make devastating trade-offs to afford their medications,” said PAN Foundation President and CEO Kevin L. Hagan. “We support this bipartisan effort and encourage Congress to end these harmful insurance policies swiftly.”
Co-pay accumulator programs cause significant harm to people with serious and complex illnesses, often leading them to ration or not take medication as prescribed. Frequently, patients are not informed about these policies before they enroll in coverage. Not only can these policies have a direct negative impact on a person’s health, but they also have unintended consequences of high costs and stress on the nation’s healthcare system.
The number of health insurance plans with these policies has become increasingly common. A 2021 report by The AIDS Institute found that two-thirds of health insurance plans available through the Affordable Care Act marketplace in 32 states include a co-pay accumulator adjustment policy.
In 14 of those states, all available health insurance plans through the marketplace include one. Residents of those states who purchase marketplace insurance will not be able to use drug manufacturer coupons toward their deductibles, coinsurance, or other out-of-pocket costs. For the thousands of people who rely on financial assistance to obtain their medications, these policies can end their ability to take their medication as prescribed.
The Help Ensure Lower Patient Copays Act would ban co-pay accumulator programs through two methods:
- Update the Affordable Care Act’s definition of cost-sharing to require that all out-of-pocket payments made by or on behalf of a patient count toward the patient’s deductible and out-of-pocket limit. This update would end co-pay accumulator programs in marketplace exchange insurance plans.
- Require that when an employer-sponsored health insurance plan offers services that are considered essential health benefits, co-pay accumulator programs cannot be applied.
The PAN Foundation has long advocated for an end to co-pay accumulator programs. Read more about our position on co-pay accumulator programs.
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 over 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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