When patients cannot afford their medications, they may receive copay assistance from a pharmaceutical manufacturer or another third-party. Generally, the third-party contributions count towards the individual’s deductible and annual out-of-pocket. However, some plans have implemented copay accumulator programs which prohibit the cost of the third-party assistance from contributing towards the individual’s deductible and annual out-of-pocket limit. A 2021 Kaiser Family Foundation (KFF) annual employer survey found that one in four large companies is now employing a copay accumulator program. The survey also found that many of the drugs subject to accumulator programs were single-source drugs with no generic equivalents. State legislatures can take action to enact laws that prohibit the use of copay accumulators and protect patients. The KFF survey can be found here. Aimed Alliance’s map of enacted copay accumulator legislation can be found here.
For an additional analysis of the KFF survey please also see the Drug Channels article here.