Copay Accumulators – Enacted Laws

Copay Accumulators

 


Arizona:

  • When calculating an enrollee’s contribution to any out-of-pocket maximum, deductible, copayment, coinsurance or other applicable cost-sharing requirement, the health care insurer that provides pharmacy benefits or a pharmacy benefits manager that administers pharmacy benefits for a health care insurer shall include any cost-sharing amount paid by either the enrollee or another person on behalf of the enrollee for a prescription drug that is without a generic equivalent.¹
  • Requires the same for prescription drugs with a generic equivalent where the enrollee has gained access to the prescription drug through prior authorization, step therapy, or the insurer’s exceptions and appeals process.¹

1: https://legiscan.com/AZ/text/HB2166/2019


Illinois:

  • Requires health plans to apply any third-party payments, financial assistance, discount, product vouchers, or any other reduction in out-of-pocket expenses for prescription drugs made by or on behalf of an enrollee toward that person’s deductible, copay, or cost-sharing responsibility, or out-of-pocket maximum.¹

1: http://www.ilga.gov/legislation/publicacts/101/PDF/101-0452.pdf


Virginia:

  • To the extent permitted by federal law and regulation, when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, a carrier shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person.¹

1: https://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+HB2515ER+pdf


West Virginia:

  • When calculating an insured’s contribution to any applicable cost-sharing requirement, including, but not limited to, the annual limitation on cost-sharing subject to 42 U.S.C. Sec. 18022(c) and 42 U.S.C. Sec. 300gg-6(b), an insurer shall include any cost-sharing amounts paid by the insured or on behalf of the insured by another person.¹
  • A pharmacy benefits manager shall include any cost-sharing amounts paid by the insured or on behalf of the insured by another person.¹

1: http://www.wvlegislature.gov/Bill_Text_HTML/2019_SESSIONS/RS/bills/HB2770%20SUB%20ENR.pdf