COPAY ACCUMULATOR FULL
As a result, when you go to refill your prescription in April, you will owe $3,000, the full cost of your drug, because the deductible has not yet been paid down. By the time March arrives, you’ve reached the limit on your co-pay assistance. You use your co-pay card at the pharmacy and make a regular co-payment at the counter. Example: It’s the start of a new health plan year in January and you are on a biologic with a list price of $3,000 a month.These programs can be called different names, are often marketed as a positive benefit, and are often disclosed many pages into plan materials, leading to a lack of awareness about them to patients. Patients are often unaware they are enrolled in one of these programs until they go to the pharmacy counter and realize they must pay the full cost of their medication, which can lead them to abandon or delay their prescription.With an accumulator adjustment program, patients are still allowed to apply the co-pay card benefits to pay for their medications up to the full limit of the cards, but when that limit is met, the patient is required to pay their full deductible before cost-sharing protections kick in. Traditionally, pharmacy benefit managers have allowed these co-pay card payments to count toward the deductible required by a patient’s health insurance plan.
Many pharmaceutical manufacturers offer co-pay cards that help cover a patient’s portion of drug costs.Accumulator adjustment programs prevent any co-payment assistance that may be available for high-cost specialty drugs from counting toward a patient’s deductible or maximum out-of-pocket expenses.
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