Accumulator adjustment programs (also known as copay accumulator programs and co-pay adjustment policies) are programs that some insurance plans are instituting that limit access to diabetes medications – many of which have no generic substitute – and devices by preventing manufacturer copay assistance contributions from counting towards a beneficiary’s deductible and out-of-pocket spending requirement. Insurance plans have been implementing accumulator adjustment programs without consumer notice, which leaves patients to find out about this practice only after they incur steep prescription drug and device cost sharing mid-year. Beyond being unfair to patient consumers, these programs will have a negative impact on individual and public health.
Accumulator Adjustment Programs and Diabetes
About 1,374,000 people in Pennsylvania (roughly 12% of the state adult population) have diabetes. People who have diabetes spend more than double on their health than people without diabetes. It makes sense, then, that people with diabetes have trouble accessing their medications when the cost-sharing burden is high. A study found that patients with type 2 diabetes are more likely to adhere to prescribed medication when they have lower copayments. Even a cost as low as a $5 copay can have an effect on adherence to diabetes treatments.
Copay cards enable patients to access their medication. People with diabetes expect to be able to use copay cards because of how commonplace they are, and many people budget their healthcare expenses for the year based on the availability of copay cards. Additionally, a person with diabetes may not be able to switch medicines in order to get a cheaper price. Among brands with copay coupons, a majority (51%) are for drugs with no generic substitute – including 12% for drugs with no close therapeutic substitute of any kind.
Changes with No Notice
In addition to the increased financial burden caused by accumulator adjustment programs, beneficiaries are not being told of the change in their insurance coverage. Beneficiaries are shocked when they find out that their plans have changed because insurance companies have not adequately informed their customers of the programs. As a result, beneficiaries have planned their healthcare budget plans as they have in previous years, only to find out that their circumstances have drastically changed.
S.B. 731 Takes Action
Pennsylvania S.B. 731 was introduced by Senator Ward and 9 others on June 7th. It was referred to the Banking and Insurance Committee that day as well. It amends the Insurance Company Law of 1921 to add language that allows any cost-sharing amounts paid by the insured or on behalf of the insured by another person. The ban would go into effect 60 days after the bill’s passage, and includes all health insurance plans except accident only, fixed indemnity, limited benefit, credit, dental, vision, specified disease, Medicare supplements, CHAMPUS supplement, long term care or disability income, worker’s comp, or auto insurance.
Raise Your Voice!
Let your Senator know that you support a ban on accumulator adjustment programs so that patients can use their copay cards and pay down their deductibles!