This program is called copay accumulator adjustment. Are you adopting these programs, or do you have future plans to adopt this program?” 2. “I’ve heard that there are programs that do not allow for my prescription copay card to be applied to my deductible as it was in the past. You can also call your health insurer directly. United Healthcare calls this “Coupon Adjustment: Benefit Plan Protection”īe aware that your health plan may change policies in 2021 if the proposed rule from HHS passes without revision.įind up-to-date benefits documents on your health plan’s website and searching for keywords like “coupon,” “copay card,” "discount," "assistance," “accumulation,” and “accumulator.” Below are what some large health groups call the policy:īlueCross BlueShield of Texas calls it “Coupons for Individual Plan Members Only”ĬVS Caremark calls it “True Accumulation”Įxpress Scripts calls it “Out of Pocket Protection” And, each health insurance plan refers to copay accumulator adjustment in different ways. Though some plans transparently list new accumulator programs in a user-friendly “Summary of Benefits” document, others do not. People who have benefited from these coupons in the past may not even be aware of the change, so the first step is to find out if this policy change applies to you. To avoid any surprises when meeting your deductible, check your plan’s most recent benefits documents. For background on why these policies are being implemented, read more below.
With the addition of these policies, many people who use discount cards – particularly those with high deductibles – will end up paying more for their supplies.
Since you’ve only paid $5 out-of-pocket, only $5 is counted toward your $500 deductible. The situation is much worse under accumulator adjustment.
#HUMIRA COPAY CARD LIMIT FULL#
Under the traditional policy, the full cost of the drug – $100 – would be counted toward your deductible, even though you’ve only paid $5 of your own money. The cost of the medication is $100, but a copay card brings down the amount you pay to $5, with the remainder paid by the drug’s manufacturer. Say your pharmacy deductible is $500, which is typical here in California for a Bronze insurance plan. diaTribe advocated, along with many other organizations, against this proposed rule. Starting in 2021, this proposed rule would make it more difficult for people to meet their deductible and thus increase how much they pay yearly for their medications. In January 2020, the Department of Health and Human Services (HHS) announced a proposed rule that would allow insurers to use these copay accumulator adjustment programs.
This is why accumulator adjustment policies are extremely damaging for people who rely on discount coupons for medications with no generic equivalent. People have traditionally been able to reach their deductible or out-of-pocket maximum while using money contributed via these coupons. Typically, these coupons decrease the out-of-pocket cost of the medication while counting the original, higher price toward an individual’s deductible (the yearly amount you pay before insurance kicks in). Many health plans do not count these coupons toward deductibles and out-of-pocket maximums – a practice called “accumulator adjustment” that increases the amount of money people pay for their medications. However, certain employers, insurers, and pharmacy benefit managers (the “middlemen” between drug manufacturers and insurance companies) have rules to try to discourage the use of discount coupons. At the pharmacy, these coupons can reduce out-of-pocket costs – sometimes by hundreds of dollars. Our deep dive into coupon policies that may affect how much you pay for prescriptions – updated for 2020ĭiscount coupons, also called copay cards, help many people with diabetes afford their medication.
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