State of Play: Copay Accumulators

December 19, 2023

Over the past few months, we’ve been sharing summaries of state-level action on the Association for Clinical Oncology’s (ASCO) key advocacy priorities. This article examines recent action on copay accumulators.

ASCO strongly opposes the use of copay accumulator programs, which some insurance plans use to prevent patients from counting a manufacturer’s copay assistance for high-cost specialty drugs towards their deductible. While disguised as a “benefit,” only once a manufacturer’s copay assistance card is maxed out do a patient’s out-of-pocket costs begin counting towards their deductible. Patients can be left with high out-of-pocket costs at the end of their plan year because the pharmacy benefit manager and insurer pocketed the manufacturer’s assistance meant for the patient.

ASCO is a member of the All Copays Count Coalition, which is comprised of over 80 patient and provider groups and leads the effort to ban copay accumulator programs at both the federal and state levels.

As of November 2023, 19 states, the District of Columbia, and Puerto Rico have passed legislation requiring insurers to count copay assistance paid on behalf of patients toward their deductibles. Another four states had bills pass one chamber of their legislature for the first time in 2023.

California, Florida, Iowa, Michigan, Missouri, North Dakota, Pennsylvania, Wisconsin, and Utah are expected to introduce and possibly act on copay accumulator legislation in 2024. If you have any questions, please reach out to Aaron Segel or visit ASCO’s state bill tracker.

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