I hate copay accumulators and you should know if your plan has one. In 2023 I ended up spending $2,000 more on my prescription drug coverage because I didn’t know a co-pay accumulator was in place.
Don’t be me, know if you have one and if your state has not banned them. Some drug manufacturers discount programs are working around this. But each one is different. Call the drug manufacturer discount program and see how they handle plans with copay accumulators.
You can click here to view the webpage I’m referring to in the video to check if your plan has a copay accumulator.
If you live in Arizona, Arkansas, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, New Mexico, New York, North Carolina, Oklahoma, Tennessee, Texas, Virginia, Washington, and West Virginia, as well as Puerto Rico, congratulations, your state has outlawed copay accumulators. That means you don’t have to worry about your health insurance plan double dipping when you use drug manufacturer discount programs.
Watch the video below
If you prefer to read it, here is the transcript:
00:00:00:16 – 00:00:17:51
I’m a passionate, patient advocate who wants to educate you on your health care plan. It’s the time of year of open enrollment, and we’re all trying to pick our different plans. And I would highly suggest that you try to avoid plans with a co-pay accumulator in place, or at least know that that is something that is in place with your plan.
00:00:18:04 – 00:00:46:31
So what’s a co-pay? Accumulator co-pay accumulators are programs within insurance plans that the manufacturers payments do not count towards the patient’s deductible or out-of-pocket maximums. So basically the insurance company is double dipping. So how do we avoid a co-pay accumulator programs during open enrollment? Well, it’s not as easy as you may think. So I went to Patients Rising Now and Talk, which is a nonprofit that advocates for the rights of patients with chronic illnesses.
00:00:46:35 – 00:01:11:31
They do it through legislation and advocacy work on Capitol Hill as well as in every state. I happen to be in the patient Senate of patients rising. So if you want more information on that, let me know. But go to the website or you can even type into Google, Avoid copay accumulator in open enrollment. I’m going to scroll down because copay accumulators are not super easy to find within individual health insurance plans.
00:01:11:31 – 00:01:33:16
In fact, I was duped last year when choosing a medical plan. I thought that I had done my due diligence and I did not. So if we scroll down to this section sample copay accumulator language so they have a couple of different samples following amounts may not be used to satisfy the benefit period deductible discounts, coupons or other amounts from third parties yada.
00:01:33:18 – 00:01:57:43
Got. Right. So I’m going to take some of these key words like coupons or manufacturers, and I am going to pull up the summary of benefits and coverage. This is normally the one sheet that you end up getting from your employer. The employer will give you the sheet. Sometimes this does not have all of the information you need.
00:01:57:50 – 00:02:19:48
In fact, I almost guarantee that this does not have the information that you need about the copay accumulator laws. If we read a little bit up in the upper section and we can see here that it says to get a copy of the complete terms of coverage, visit the blah blah EOC. The EOC is this If I click on the link, it would go here.
00:02:19:48 – 00:02:31:29
So you’re going to come to this document, the evidence of coverage booklet. This has all of the information about your potential medical plan that you’re trying to get or that you’re at least looking into because you’re trying to figure out what you want.
00:02:31:40 – 00:03:19:20
So I’m going to find I’m going to search for coupon. Let’s see if that. Okay. While so the document finished searching and it’s telling me that there were no matches found. So now I’m going to type in discount. Oh, there it is in all of its glory in an area that you would never suspect deep down in this document, under obtaining specialty drugs from a network specialty pharmacy, there is a statement here that talks about drug manufacturers or other third parties may offer drug discounts or copayment assistance for certain drugs.
00:03:19:25 – 00:03:51:04
These types of programs can lower your out-of-pocket cost if you receive any discounts at a network specialty pharmacy, only the amount you pay will be applied to any applicable deductible and out-of-pocket maximum. This one tiny statement tells us that this particular plan has a copay accumulator in place. Now, there are a lot of states in the country that have banned copay accumulators, and so a lot of states will not have to deal with this.
00:03:51:04 – 00:04:03:05
But I live in California, and unfortunately last year we were trying to get a copay accumulator ban put through the health committee, but it was stopped. So we’re regrouping and we’re trying again next year.
00:04:03:05 – 00:04:17:45
there’s also the help Co-pays Act, which is also trying to help ban copay accumulators because copay accumulator programs really are a disservice to people that take medications that are especially expensive, like biologic medications.
00:04:17:50 – 00:04:38:45
A lot of the manufacturers of biologic medications offer patient assistance programs simply because their drugs tend to be the highest tier, the tier four drugs. So they can be 250 every single month or $500 or even more. If you have deductibles that you have to meet first. So educate yourself just a little bit and see whether or not your plan has a copay accumulator.
00:04:38:45 – 00:04:42:28
And tell me down below does your plan have a copay accumulator?