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 2,047,000 people in New York (roughly 12.2% 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 recent 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.
New York bills A. 8246 / S. 6303 ban accumulator adjustment programs by requiring insurance plans to apply payments from third parties on a patient’s behalf to apply to the patient’s deductible, copayment, coinsurance, and out-of-pocket maximum. The bills apply to all insurance plans sold in the state.
NY S.6303 was introduced by Senator Rivera on June 3rd. It was moved to the Rules Committee that same day. The Assembly companion bill, A. 8246, was introduced by Assemblyman Gottfried on Monday, and was referred to the Insurance Committee. The bills are also positive bans that require insurance plans to apply payments from third parties on a patient’s behalf to apply to the patient’s deductible, copayment, coinsurance, and out-of-pocket maximum. The ban would go into effect the January after the bill is passed.
Let your state representatives know that you support A. 8246 and S. 6303, and ask them to cosponsor!