Medical copay accumulator program could cost patients | Commentary
February 12, 2021
By Jared Willis | Orlando Sentinel
As the COVID-19 pandemic continues to affect Floridians’ health and income, it is more important than ever for health care to be affordable, especially for those with chronic conditions. Unfortunately, a cost-saving strategy utilized by many health plans and third-party payers may end up costing patients thousands of dollars rather than lowering costs.
Often for expensive specialty drugs (which in many cases are prescribed for the management of chronic conditions), manufacturers will offer copayment assistance or discount coupons. Traditionally, patients apply for these cost savings, which then apply towards the patient’s copays or out-of-pocket maximums, saving the patient money on much-needed medication. In many cases, these savings are the difference between being able to afford medication or having to go without necessary treatment.
In some cases, these discounts will cover the patient’s costs and extend rebates or discounts to the health plans for their portion of the medication. But as of a Health and Human Services ruling in July 2020, “copay accumulator programs” — often appearing under many different names, such as “Benefit Plan Protection” or “Coupon Adjustment” — no longer apply these savings to the patient’s out-of-pocket costs, leading to surprise expenses when the discounts are exhausted.
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