ACR Leads Resolution to Address Copay Accumulator Policies at AMA House of Delegates Meeting

At the American Medical Association (AMA) House of Delegates Special Meeting this month, the ACR will lead a resolution that, if passed, will direct the AMA to advocate for copay accumulator bans in state legislatures and at the federal level. Several other specialties have joined the ACR-authored resolution as cosponsors, including dermatology, neurology, ophthalmology, oncology and gastroenterology, along with the state medical associations for Georgia and New Jersey.

Copay accumulator polices, implemented by payers, prevent copay assistance funds from being applied towards patients’ deductibles or out-of-pocket maximums. They allow payers to collect both the full amount of the copay assistance provided to the patient and the full amount of the deductible directly from the patient, leading to higher out-of-pocket expenses for patients. This creates a financial barrier to treatment and hurts patients’ abilities to afford their medications. Copay assistance funds are often exhausted in the middle of a plan year, forcing patients to pay their full deductible out-of-pocket or discontinue their medication.

The AMA House of Delegates Special Meeting will be held virtually Nov. 13–17. During this meeting, the ACR’s delegation will advance its Resolution 212, Copay Accumulator Policies, that would direct the AMA to:

• Directly engage and advocate for the adoption of proposed state legislation or regulation that would ban copay accumulator policies in state regulated health care plans, including Medicaid; and
• Directly engage and advocate for the adoption of proposed federal legislation or regulation that would ban copay accumulator policies in federally regulated Employee Retirement Income Security Act (ERISA) plans.

Joining as cosponsors of the ACR resolution are the American Academy of Dermatology, American Academy of Neurology, American Academy of Ophthalmology, Association for Clinical Oncology, Society for Investigative Dermatology, American College of Gastroenterology, Medical Association of Georgia and Medical Society of New Jersey.

It is important, especially during the COVID-19 public health emergency, to ensure that patients stay on their medications. Copay accumulator policies threaten patient access to medications by preventing funds received from copay assistance programs from being applied to patient deductibles. Once assistance funds are exhausted, a patient must pay the full deductible out-of-pocket and may be forced to discontinue treatment.

Adding to this urgency, United Healthcare (UHC), which controls 14.1% of the U.S. health insurance market, recently announced that it plans to use physicians to enforce accumulator polices by requiring them to report when a patient uses copay assistance for specialty medications. This policy, if implemented, would threaten continuity of care of millions of patients at a time when they are most vulnerable to care disruptions.

Four states have already banned UHC-style accumulator policies. As state legislatures begin their 2021 sessions, the ACR contends that it is urgent for the AMA to have a clear policy to support accumulator ban legislation that protects patient access to critical therapies.

The ACR considers and introduces resolutions at AMA meetings based on its positions and policies and the work of key ACR committees and the Board of Directors. ACR members are asked to help this work to advance rheumatology issues by joining the AMA and renewing their AMA memberships each year. Rheumatology’s voice at the House of Delegates meeting is determined based on the number of ACR members who are also members of the AMA, so every single person who is both an ACR and an AMA member adds to the strength of this effort. Join or renew your AMA membership before 2020 comes to a close and receive valuable membership benefits along with helping to advance rheumatology.

The ACR’s delegation to the AMA House of Delegates consists of Gary Bryant, MD (Delegate and Delegation Chair), Eileen Moynihan, MD (Delegate), Colin Edgerton, MD (Alternate Delegate), Cristina Arriens, MD (Alternate Delegate), Luke Barre, MD (Young Physician Section representative), Christina Downey, MD (Young Physician Section representative), and Rami Diab, MD (Resident and Fellows Section representative). Questions and suggestions for the AMA delegation’s work on behalf of the rheumatology can be directed to advocacy@rheumatology.org.