Make All Copays Count: AHDA Signs Onto Letter Urging for the Elimination of Copay Accumulator Programs

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The rise of deductibles and out-of-pocket expenses for medications has resulted in many headache disorder patients relying on financial assistance from drug companies and nonprofits. However, even with insurance, many insurers and pharmacy benefit managers (PBMs) have policies that make it challenging for many headache patients to afford their much needed medications. 

Copay accumulator policies are used by many insurers and PBMs. These policies allow insurers to receive a patient’s copay through copay assistance programs but not count those payments towards a patient’s deductible. This allows for insurers and PBMs to double-dip and make a higher profit while many patients struggle to afford their needed care as they still must meet their deductibles through other means.. 

The Alliance for Headache Disorders Advocacy has been working on this issue as a part of the All Copays Count Coalition (ACCC). We believe that any copayments that are made either by or on behalf of a patient should be counted as payments towards a patient’s annual cost-sharing contributions. Headache disorder patients are particularly vulnerable to co-pay accumulator programs as many patients rely on co-pay assistance programs and many treatments lack a generic option resulting in higher out-of-pocket costs for patients. 

To that end, the AHDA recently joined 75 other organizations in signing onto a letter addressed to the U.S. Department of Health and Human Services, the U.S. Department of Labor, and the U.S. Department of Treasury. The letter urges the Departments to build on existing rules while maintaining the protections that were included in the 2020 Notice of Benefit and Payment Parameters which would require copays made on behalf of a patient count towards that patients’ cost-sharing requirements. The letter also urged the Departments to ensure that copay assistance counts for medically appropriate medications whether the brand is generic or not. Finally, the letter urged that any provisions allowing copay accumulator adjustment policies related to Health Savings Accounts (HSAs) are limited to patients who would be deemed ineligible to contribute to an HSA while using copay assistance. 

The Alliance for Headache Disorders Advocacy (AHDA) will continue to work on the issue of copay accumulators to ensure all headache disorder patients can access the treatments they need to live their fullest lives, including by passing the bi-partisan HELP Copays Act. You can take action for PBM reform including support for the HELP Copays Act today via our easy form. Be sure to add in your own personal story as to why these issues matter to you! 

Read the full All Copays Count letter below!