Saud Anwar

Senator Anwar Votes in Favor of Prohibiting Insurers from Implementing Copay Accumulator Programs

Today, State Senator Saud Anwar (D-South Windsor) voted in favor of legislation that would prohibit insurers from implementing Copay Accumulator programs. A copay accumulator is a strategy used by insurance companies and Pharmacy Benefit Managers (PBMs) that stop copay assistance coupons from counting toward a patient’s deductible. These programs use patients as hostages in the battle of insurers and pharmacy benefits managers versus pharmaceutical companies. The legislation passed the Senate unanimously.

“This bill seeks to prevent a practice that takes advantage of individuals seeking health care and actually increases their cost of care, saving insurance providers in the process,” said Sen. Anwar. “These copay accumulator programs serve to artificially extend a patient’s spending before they reach a deductible; in some cases, they are designed specifically to make a patient pay more before their care cost is shared by an insurance provider. By prohibiting these programs, we provide those getting care in our state with additional financial security, as well as the knowledge that they are not being taken advantage of.”

Senate Bill 1003, An Act Prohibiting Certain Health Carriers And Pharmacy Benefits Managers From Employing Copay Accumulator Programs, would require certain health carriers and pharmacy benefits managers to give credit for payments made by third parties for the amount of, or any portion of the amount of, an insured’s or enrollee’s cost-sharing liability for a covered benefit.

While the high price of prescription drugs is an enormous problem, the answer to this problem is not taking more money from patients. According to Geoffrey Joyce, a pharmaceutical economist at the University of Southern California, “There are no good guys here, this is about control of the market. The only thing that’s clear is who loses. The loser is the patient.”

Copay Accumulators have been present in the specialty pharmacy space for oral drugs for some time, causing many challenges for chronically ill patients as they fall under financial hardship. This hardship can increase the likelihood of treatment non-adherence and can ultimately lead to advanced disease state. Additionally, patients who continue treatment may incur significant debt for long term costly treatments.

Under Copayment Accumulator programs, any copayment assistance that a patient receives, whether it be directly from a pharmaceutical manufacturer or from coupon cards such as Good RX, it does not count toward the patient’s deductible. Patients must spend more out of pocket to reach their deductible, sometimes thousands of dollars more. For too many patients, this makes the drugs they depend on unaffordable.

It appears that these programs may allow insurers to double dip because they get their full co-pays while also extending the duration of patients’ deductibles. Connecticut should protect its residents from this practice.