If you suddenly find yourself paying more out of pocket for your prescriptions, you’re not alone. Millions of patients across the country are being surprised by costs at the counter, and it’s likely due to a little-known policy insurance companies are using to try and squeeze more money from patients with chronic conditions.
The policy? It’s called a “copay accumulator” – and you probably don’t know if it’s even part of your current insurance plan.
Americans are sick and tired of rising prescription costs. Eight in 10 U.S. adults say prescription costs are “unreasonable,” and one in four say their prescription medicines are difficult to afford. For many patients with chronic conditions like HIV, hemophilia, multiple sclerosis, cancer, and more, prescription drug companies and nonprofits offer coupons that can be used at the pharmacy counter to help bring down costs.
Unfortunately, insurance companies are pushing for changes that prevent these coupons from reducing costs at the counter. By mandating that the coupons can’t count toward patients’ deductibles, patients are on the hook for the full cost of their medicine with no help from insurance once the coupons run out.
Insurance companies’ copay accumulators policy is muddled and often hidden deep within the hundreds of pages of insurance policy fine print. To make matters worse, medicines used to treat serious and chronic conditions such as HIV or multiple sclerosis are the ones that fall into this insurance black hole – medicines that patients must have in order to maintain a basic quality of life.
Imagine a loyalty rewards program at your favorite coffee shop. After a few months of trading stars for free cups of coffee, the barista suddenly tells you they’ve been keeping track of all of the free coffee, and you now owe all the money for the past months’ free coffee, plus full price on coffee for the rest of the year. You’d probably walk out in a huff and pick a new coffee shop, right?
Insurance companies argue that these coupons offered from drug companies and patient advocacy organizations de-incentivize patients from seeking out cheaper medication. But why are insurance companies trying to come between a patient and their doctor?
Now imagine a much more serious version of the coffee shop scenario – one where there is no choice to walk away without endangering your quality of life. Studies show that when faced with paying full cost for medications, many people simply can’t afford it and walk away from the pharmacy without their medication. One recent study found 69 percent of patients who were faced with paying more than $250 out of pocket chose not to get their medication.
Recently, the federal agency in charge of administering and regulating this type of policy announced their payment rules for 2021, with no mention of preventing “copay accumulator” policies. If nothing changes and these policies remain in place, you or people you know will continue to suffer.
Cost should not come between someone and their quality of life. No one should have to go to the prescription drug counter only to walk away without their medication because insurance companies are trying to game the system.