Accumulator adjustment programs 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 maximum out-of-pocket spending limits.
Without consumer notice, insurance plans have been implementing accumulator adjustment programs. This causes patients to unexpectedly encounter steep prescription drug and device cost sharing mid year.
Copay Cards and Affordable Access
Copay cards are used by patients to affordably access their medications and, often, patient heavily rely on these to budget their healthcare expenses. Few cost-effective medication alternatives are available to diabetic patients, causing a particular necessity for copay cards. 51% of copay coupons are for drugs with no generic substitute, 12% of which have no close therapeutic substitute at all. People with diabetes spend approximately 2.3 times more on healthcare than people without diabetes, causing accumulator adjustment programs to be disproportionally unjust to the diabetic community. Recent research shows that patients with type 2 diabetes are more likely to adhere to treatment protocol with lower copayments. Copay cards offer a means of assistance to overcome the cost hurdle of diabetes and assist in medical compliance.
H.B. 2515/S.B. 1596 requires that any carrier issuing a health plan in the Commonwealth to include any amounts paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to any out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing requirement under the health plan. Simply put, H.B. 2515/S.B. 1596 assists patients in their health care cost management by including copay cards in their cost-sharing requirements.
Accumulator Adjustment Programs and Cost Increase
In addition, H.B. 2515/S.B. 1596 alleviates financial burden by preventing unexpected changes to patient’s heath care plans. Accumulator adjustment programs currently increase patient cost-sharing and cause beneficiaries to be uninformed of such programs. This causes beneficiaries to be faced with high-unforeseen costs that they often are unable to afford.
Banning accumulator adjustment programs allows diabetes patients to affordably manage their healthcare through utilizing copay cards and preventing unforeseen changes in their health coverage plans. Click here to send a letter to Virginia lawmakers in support of H.B. 2515/S.B. 1596!