HHS Allows Plans to Implement Copay Accumulators Without Any Patient Protections


On May 7, 2020, the Departments of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters for 2021 final rule, which allows health plans to implement copay accumulator programs regardless of whether or not a generic alternative is available. When patients cannot afford their medications, they may rely on copay assistance (i.e., coupon cards from drug manufacturers). These coupon cards not only contribute toward the patient’s copay but also count toward the patient’s annual deductible. These programs have been especially helpful for individuals enrolled in high deductible health plans (HDHPs) in which patients are required to pay significantly high out-of-pocket costs until their deductibles are reached. However, health plans are increasingly implementing copay accumulator programs, which are policies that prevent the value of the coupon from counting toward a patient’s deductible. Copay accumulators make medications unaffordable for many patients. When patients cannot access their medications, they are at risk for adverse events and disease progression.

Last year, HHS finalized the Notice of Benefit and Payment Parameters for 2020 (NBPP 2020). NBPP 2020 would have only allowed health plans to implement copay accumulators when both a brand and generic medication were available. The rule was intended to steer patients to less costly, generic medications when possible. Last year’s rule was a major win for patients with chronic, rare, and debilitating diseases who do not have access to alternative, less costly medications. While it created appropriate cost-saving incentives, it also inherently prohibited copay accumulators in instances in which generic alternatives were not available. This year’s rule revokes those protections. Instead, NBPP 2021 explicitly allows health plans to implement copay accumulators in all instances. It limits patients’ access to medications, putting their health at risk and potentially increasing costs to the health system. Read the rule here.


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