Patients Rising Now applauds the proposed legislation by both the Virginia Senate (SB 1596) and Virginia House (HB 2515) banning the use of copay accumulator adjustment programs in the state, protecting Virginians who need this vital assistance.

In 2018, many insurers and pharmacy benefit managers (PBMs) introduced copay accumulator programs to the American public, using such pleasant sounding names as “Out of Pocket Protection” and “Coupon Adjustment: Benefit Plan Protection” to lull consumers into believing this new system is a positive step. 

However, just the opposite is true: instead of applying the value of drug manufacturers’ copay cards and coupons to offset patients’ out-of-pocket costs for certain medicines, insurance companies now expect patients who use copay coupons to personally pay their deductibles, which could mean thousands of dollars in unexpected medical expenditures. Worse still, patients are likely to face these costs in the middle of the plan year after their deductibles have been reached when they are presented at the pharmacy counter with a price tag for their medicines they simply can’t afford. Thus, copay accumulators are only a “benefit” for health plans who will save big money by changing the rules and not covering the cost of prescriptions when patients reach their annual deductibles and out-of-pocket maximums.

Speaking for patients fighting serious diseases, health plan copay accumulator programs are a discriminatory practice that limits access to needed medicines and puts patients’ health at risk.  Therefore, our goal is to work with stakeholders to advance policy solutions that protect patients from deliberate financial toxicity and clinical harm, especially when patients are medically underserved and/or are treated with medications that have no generic alternatives.

Read our full issue brief: Telling the Truth About Copay Accumulators