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.
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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.