UnitedHealthcare Delays Copay Accumulator Policy

UnitedHealthcare (UHC) announced a delay in their medical benefit copay accumulator policy which was set to take effect Jan. 1, 2021. As previously reported, the policy would have required providers to report the amount their patients receive in copay assistance for office-administered treatments. UHC had then planned to use this information to enforce a copay accumulator, ensuring that no copay assistance funds would be applied toward patients’ deductibles or out-of-pocket maximum payments.

The ACR, along with a number of other provider and patient organizations, expressed serious concerns about the impact of accumulator policies on patients’ ability to access treatment. When an accumulator is enforced, copay assistance funds are exhausted in the middle of the plan year and patients are forced to pay out of pocket or discontinue or switch treatments. The UHC policy also would have placed providers in an ethically objectionable position by requiring they report information that would be used to harm patients.

ACR appreciates UHC listening to feedback from stakeholders and we applaud the decision to indefinitely delay the accumulator policy. We are aware, however, that UHC is continuing to explore other options to reduce spending on specialty drugs as they noted ongoing pressure from plan sponsors to reduce costs. ACR will continue to dialogue with UHC as the payer explores other ways to rein in spending without jeopardizing patient access.

For questions regarding this policy or other insurance coverage concerns, contact practice@rheumatology.org.