On February 9, 2022, Aimed Alliance announced it was launching a Copay Accumulator 101 Hub. When patients cannot afford their medications, they may rely on financial assistance, often called copay assistance, from pharmaceutical manufacturers and other third parties to meet their health plans’ cost-sharing responsibilities in order to fill their prescriptions. Typically, copay assistance can contribute to a patient’s cost-sharing requirements including the patient’s deductible and annual out-of-pocket limit. However, health plans can implement copay accumulator programs which prohibit the copay assistance from counting towards the patient’s cost sharing requirements resulting in increased costs for patients. In recent years, health plans have created and modified the typical copay accumulator programs in the form of copay maximizers and programs that classify certain prescription drugs as non-essential health benefits. High deductible health plans (HDHP) with health savings accounts (HSA) have also imposed additional barriers to accessing copay assistance as a result of the Internal Revenue Service’s interpretation of its 2004 Notice relating to discount cards.
To help clarify some of the confusion surrounding the variations of these copay accumulator programs, Aimed Alliance has launched a Copay Accumulator 101 Hub. Aimed Alliance’s new resource provides an explanation of how copay accumulators and copay maximizers programs operate as well as an explanation of a new non-essential health benefit scheme that has been more frequently adopted and how this scheme potentially violates the ACA. Lastly, the Copay Accumulator 101 Hub provides information on how the 2004 IRS notice relating to HDHP and HSA plans should not impair copay accumulator reform. Aimed Alliance’s new Copay Accumulator 101 Hub can be found here.