Share your story with co-pay accumulator policies

Have you received a surprise bill at the pharmacy counter?

Thank you for sharing your experience with co-pay accumulator programs!

Every story we receive will help raise awareness about these harmful programs and encourage our elected officials to ban the policies.

Use this form to share your experience with your commercial insurance policies and the impact of your higher out-of-pocket medication costs.

Type as much or as little as you like. You can even attach photos and videos below to help us form a deeper connection with your responses.

Co-pay accumulator story form

Step 1 of 2

First name*
Last name*
Email*
State*
Did you know your insurance had a co-pay accumulator program? Have you heard of these policies before?*

Have you ever had to pay more out-of-pocket because of these policies? Tell us about your experience and the impact of your higher out-of-pocket medication costs.*
Are you interested in future speaking opportunities about your experience with these harmful co-pay accumulator programs?*
If you would like to include photos or videos with your story, please upload them in the box below.
Drop files here or

Accepted file types: jpg, gif, png, jpeg, mp4, mov, Max. file size: 50 MB, Max. files: 6.
Size limit for each file is 50 MB; maximum of 6 files.
Please consent to our Terms and Conditions

Please read this carefully before you share your story and any personal information or media with us. By submitting information to the PAN Foundation and clicking “I agree,” you’re confirming that you have read, understand, and agree to the PAN Foundation’s Terms and Conditions as follows:
- You understand and agree that we may use your content for any informational, fundraising, or promotional purposes.
- You understand and agree that we can use and display any of your content and personal information that you provide in any format.
- You give us the right to verify the information you submit with other information we may have in our files.
- You give us the right to contact you for additional information if we think it would be helpful or necessary to do so.
- You understand and agree that you will not be paid or reimbursed in any way for your content or other information you provide to us.
- You consent to the use, distribution, and redistribution of your content and information by the PAN Foundation and its employees, contractors, and representatives.
- You understand and agree that you do not have the right to inspect or approve any finished product.
- You release and agree to indemnify and hold harmless the PAN Foundation, its employees, contractors, and representatives from any claims, lawsuits, injury and/or damages as a result of the content and information you provide to us.
This includes but is not limited to claims for personal injury (including injury to reputation), property damage, invasion of privacy and/or breach of confidentiality.
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Share your story with co-pay accumulator policies

Have you received a surprise bill at the pharmacy counter?

Co-pay accumulator story form

Step 1 of 2

Please consent to our Terms and Conditions