Accumulator Adjustment Programs (AAPs) and Maximiser Programs are tools utilized by insurers and pharmacy benefit managers (PBMs) to exclude co-pay assistance as an out-of-pocket expense. This, in turn, excludes co-pay assistance from being applied to a patient’s deductible.
For patients with complex, chronic conditions, co-pay assistance is vital. Typically, it offers these patients access to their necessary medical therapies at a reasonable rate; however, when it is excluded as an out-of-pocket expense, cost of care skyrockets. Patients are then left to choose between two options: endure outrageously high medical costs, or discontinue their successful treatment, leading to adverse health effects.
Nothing is more important to our organization than a patient’s health. That is why co-pay assistance should count towards the deductibles of patients with chronic conditions. We also emphasize that insurers have a responsibility to clearly notify patients of any existing accumulator adjustment or maximiser programs.
CSRO is a member of the All Copays Count Coalition (ACCC), which works to support state and federal legislation to ban accumulator adjustment programs. Our members have provided testimony to various committees from around the country and have submitted letters of support through targeted grassroots campaigns that all members may access.
Visit our Legislative Map Tool to read about current accumulator adjustment ban laws or legislation in your state. You can send letters in support of pending legislation and find educational materials.