Learn more about Copay Accumulators
If you are a health plan member, you may have heard about Copay Accumulators, but you are probably not sure how they work. These prepaid cards allow you to pay for prescriptions in advance, making it easier for you to take advantage of special discounts and benefits. While they don’t affect your deductible or annual limit, they can affect your specialty drug uptake. According to one study, patients who are enrolled in health savings account plans have lower monthly fill rates, higher rates of discontinuation, and fewer days covered.
The negative impact of Copay Accumulators is clear. If you have to pay a 30% coinsurance for a specialty drug prescription, you will pay a minimum of $3,000, with no other health care expenses. With a copay offset program, your employer pays the entire cost, which means you won’t pay a dime. But if you can afford the deductible, why aren’t you?
Using a copay accumulator program can reduce your overall cost of care. For example, a 30% coinsurance for a specialty drug prescription is more affordable than paying a high coinsurance for the same drug. The deductible for a specialty drug may be higher than $3,000, resulting in an out-of-pocket maximum of $6,000. This is the financial impact of using a copay accumulator.
Despite the positive impact of Copay Accumulators on overall costs, they do have a negative impact on the patient’s pocketbook. For example, a coinsurance for a specialty drug prescription is 30%, and the patient must pay a $3,000 deductible. If the out-of-pocket maximum is $6, then the patient will be required to pay the full cost of the drug. The accumulated costs are a drain on a doctor’s budget, which is already stretched thin.
Increasing numbers of Americans are covered by a high-deductible health plan. Many PBMs are considering implementing copay accumulators, a strategy that applies the annual maximum of manufacturer financial assistance to prescription costs. Moreover, patients with the highest deductibles are also more likely to use a copay accumulator program. This method is not a perfect solution, but it can increase the affordability of medical insurance.
In the past few years, Copay Accumulators have gained a considerable amount of popularity among plan sponsors. They allow plan sponsors to advertise to patients that they have no out-of-pocket obligation. However, the increase in use of these products has led manufacturers to reduce copay assistance for patients who have opted to opt for Copay Accumulators. For these reasons, they are now less popular than other programs.
In the past year, CMS has been inconsistent. It has approved two separate proposals to restrict Copay Accumulators in 2019. But, the latest rule doesn’t mention any such changes, which is good news for patients. For now, the accumulators will remain available to patients who don’t have a high-deductible health plan. In addition to the CMS’s inconsistent decisions, it is also important to consider whether you will use these programs when you are looking for a copay accumulator.
The Copay Accumulator model is a common option for patients with high-deductible health plans. This type of plan allows you to save money on prescription costs by paying the deductible in full. The manufacturer, meanwhile, will pay the bill for any additional copays you have to pay. As long as you don’t have an excess of cash to cover copay accumulators, you should be fine.
The Department of Health and Human Services (HHS) has approved copay accumulator programs and has not yet restricted them to generic drugs. The only difference is the way that a copay accumulator program is implemented. Some insurers require patients to participate in the program, while others offer it to all patients as a supposed benefit. Regardless, a copay accumulator program is a great alternative to copay accumulator programs.
As the AIDS Institute explains, the Copay Accumulator program has the potential to increase the cost of life-saving medications. Because these accumulators are designed to help patients with copays, these programs are a great way to reduce the out-of-pocket expenses for life-saving medications. If you want to make the most of this benefit, you should consider enrolling in the program. If you don’t have an accumulated card, you might be surprised at how much you can save.
