Posted: September 27, 2018
The CSRO has been deeply concerned about the expanded implementation of a new utilization management tool known as co-pay accumulator programs over the course of 2018. As many physicians and patients have been made aware, co-pay accumulator programs allow health plans to exclude co-pay assistance as an out of pocket expense for the purpose of meeting a patient’s deductible or out of pocket maximum.
CSRO has worked with a broad array of partners over the course of the past year to raise awareness about the issue, and document cases of harm amongst patients across the United States. As 2018 comes to a close, and stakeholders look to gather solutions to the problem, new data has emerged regarding the prevalence of co-pay accumulator programs.
Data gathered by Zitter Health Insights indicates that these programs have been widely implemented by health plans, and that many plans have set up accumulator programs for implementation in 2019. An analysis of the findings conducted by the Drug Channels Institute found that 44% of enrollees in commercial plans are subject to an accumulator, roughly two-thirds of which have seen the tool implemented this year.
Interestingly enough, some plans have begun implementing “co-pay maximizers,” which spread the full value of a co-pay card over the course of the year, rather than refusing to apply any amount towards a patient’s deductible. Patients will still pay more over the course of the year than they are traditionally used to, but far less than the accumulator scenario.
CSRO continues to collect stories from those being affected by co-pay accumulator programs. Please contact us if you wish to share your story with us.