Here in Massachusetts both chambers had bills introduced last session to ensure patients are able to include any cost-=sharing amounts paid towards their deductible. Speaking as a nurse, it is painful to put patients in a position where they need to balance whether they can afford medicine all because insurers are needlessly and cruelly separating out the source of payment. By labeling these medicines “non-essential,” health insurers pocket extra money and patients are left footing the bill. In that scenario, the patient is forced to pay that $250 for each treatment, without ever hitting the maximum out-of-pocket cost. That means only the patient’s $250 counts toward the deductible and annual maximum out-of-pocket cost. But in a health insurance plan with a copay accumulator, payments made by someone other than the patient are excluded from the deductible and the annual maximum out-of-pocket cost.
It would make sense for the entire $1,000 paid out by a combination of the assistance program and the patient to count toward their deductible and the maximum annual out-of-pocket cost. What does that mean in practice? Let’s say a patient has a $1,000 copay for a medicine but is enrolled in a manufacturer assistance program which covers $750 of the treatment. A copay accumulator is a mechanism that allows insurers and pharmacy benefit managers to not count the cost of assistance programs supporting “non-essential” medicine towards a patient’s out-of-pocket maximum or deductible. These give patients from all income levels the ability to access the most innovative treatments, but if the treatment is deemed non-essential, language in their health insurance plan that most people don’t even know exists called a “copay accumulator” may kick in. To help get patients the care they need, nonprofits and even some pharmaceutical companies themselves offer coupons, vouchers, and copay assistance programs. And in a field with quick moving innovation like medicine, sometimes cutting-edge drugs and treatments get that “non-essential” classification when they are anything but non-essential.Ĭost should never be a factor for patients with lupus, cystic fibrosis, and other chronic and life-threatening illnesses.
#Accumulator insurance plan how to
Our primary concern is how to best treat patients, but unfortunately cost always lingered in the back of my mind – especially for new treatments deemed “non-essential” by insurance companies and their Pharmacy Benefit Managers. Having worked in nursing for over 30 years, I know first-hand the personal pride we take in our work. HEALTH CARE PROFESSIONALS wake up every day with their patients’ wellbeing on their mind.
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