Some Health Plans Exclude Manufacturer Copay Assistance from Deductible and Out-of-Pocket Maximums

Health insurers are implementing policies that exclude manufacturer copay assistance from counting toward patient deductibles and out-of-pocket maximums, a practice known as copay accumulator programs. When drugmakers provide financial assistance to help patients afford expensive medications, these programs prevent those payments from reducing the patient's cost-sharing obligations under the plan. Patients effectively pay twice — once through the manufacturer assistance that does not count toward their deductible, and again when they must meet the full deductible out of their own pocket. This practice affects managed care plans' pharmacy benefit design and patient access to high-cost specialty medications.

Pharmacy · Managed Care