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Ban co-pay accumulator and maximizer programs


Co-pay accumulators, maximizers, and 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, maximizer, and similar 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.

These 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