How Policymakers Can Stop Patients’ Co-Pay Surprise

Can policymakers prevent new co-pay accumulator programs from surprising patients at the pharmacy counter?  The short answer: yes. They have several options, in fact, according to a new overview of policy proposals from the Institute for Patient Access.  

The document follows the June release of IfPA’s “Co-pay Accumulator Adjustment Programs” policy brief.  In it, Alliance for Patient Access member Madelaine Feldman, MD, explains that accumulator programs prevent co-pay cards from counting toward a patient’s annual deductible, often without the patient’s knowledge. Patients may then be surprised at the pharmacy when, after several months, their card has been used up and they find that they owe their entire deductible.  Patients who can’t afford their deductible may abandon their prescription.

Co-Pay Accumulator Programs: How Can Policymakers Protect Patients?” notes that ensuring patients’ continual access to their medication requires viable policy solutions.  The document highlights several possibilities.


  • Policymakers could require that insurers notify patients if their plan includes an accumulator program.  Insurers would be required to provide an easy-to-understand explanation of their co-pay accumulator program’s impact on patients.  This concept addresses a primary concern of patients and patient advocates.  In May, the HIV Health Care Access Working Group, a national coalition of HIV service organizations, noted in a letter to Texas’ Insurance Commissioner that plans are implementing these policies “with no consumer notice … leaving consumers to find out … mid-year.”

  • Another option is for policymakers to limit the use of co-pay accumulators.  The National Organization for Rare Diseases recently explained the significance of restricting the programs or limiting their negative impact on patients by amending federal law.  The move would protect patients from “untenable increases in their health care costs,” the organization explained.
  • As another potential solution, policymakers could require out-of-pocket cost transparency, which could prevent patients’ financial distress.  High-deductible plans could unknowingly burden patients with unmanageable monthly expenses.  And millions of Americans could benefit from a clear demonstration of annual out-of-pocket costs.
  • Finally, policymakers could support patients’ ability to receive financial support without penalty. Insurers should be prevented from penalizing patients for receiving assistance through manufacturer support or other assistance programs.

Not taking one’s medicine can lead to additional health complications, expensive emergency care and even preventable hospitalizations.  By taking action, policymakers can stop patients from paying the price for co-pay accumulator programs – with their pocketbooks and their health.

To learn more, read “Co-Pay Accumulator Programs: How Can Policymakers Protect Patients?” and the policy brief “Co-pay Accumulator Adjustment Programs.”

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