How Insurers Use Copay Accumulator Programs to Undermine Drug Assistance for Patients
This article investigates how health insurers use "copay accumulator" programs to prevent drug manufacturer copay assistance coupons from counting toward patients' deductibles and out-of-pocket maximums. Through the story of Larry Gruber, a patient with psoriatic arthritis who relied on an Enbrel coupon card for 16 years, the article explains how insurers have shifted to policies that pocket copay assistance funds while leaving patients with unexpected bills. It covers the financial impact on patients, the role of pharmacy benefit managers (PBMs), state-level bans in some states, stalled federal oversight, and the broader implications for healthcare affordability in the U.S.
Key quotes
For 16 years, Larry Gruber, a fitness coach from Wilton Manors, Florida, received a coupon card to help him pay for a psoriatic arthritis medication he needs that costs more than $7,700 a month.
Using the card, Gruber usually met that maximum by February, leaving his health insurance to fully cover his in-network medical costs and reducing his cost for the drug to $0 for
While some states ban insurers from using copay accumulator programs, oversight has stalled at the federal level.
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