Key Features of State Copay Accumulator Laws
- Prohibition of copay accumulator programs. Twenty-one states have outright banned the use of copay accumulator programs. These laws mandate that any third-party payments, including manufacturer assistance, must be applied to a patient’s deductible and out-of-pocket maximums.
- Transparency and notification requirements. Other states focus on transparency, requiring insurers to clearly inform patients about the existence and impact of copay accumulator programs. These laws may not prohibit the programs but ensure patients are fully aware of how their copay assistance will be applied.
- Scope of legislation. Legislation in different states varies in scope, affecting different plans. Some laws apply to all health plans within the state; others may apply only to plans sold through the state’s health insurance marketplace or may exempt specific insurance, such as Medicaid or state employee health insurance. Some legislation applies only to assistance from charitable organizations and not that from manufacturers.
Conclusion
State copay accumulator legislation represents a critical step in safeguarding patient access to necessary medications and ensuring that financial assistance reaches those who need it most. Although challenges remain, the continuing evolution of these laws reflects a commitment to patient-centered healthcare and equitable access to treatments. As more states consider and implement this legislation, the collective impact on public health could be substantial, paving the way for a more supportive and transparent healthcare system.
