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Patient Advocates Warn Against New Insurance and Pharmacy Benefit Manager Policy That Increases Patient Out-of-Pocket Drug Costs Posted

By Christina Jensen


As Open Enrollment Begins, Beneficiaries who Rely on Copay Coupons Must Consider this New Policy When Selecting a Health Plan

The AIDS Institute, Arthritis Foundation, and National Organization for Rare Disorders (NORD) hosted a press briefing on a harmful new health insurance and Pharmacy Benefit Manager (PBM) policy quietly being slipped into insurance plans and dramatically increasing patient cost sharing for prescription drugs.

As open enrollment is set to begin, beneficiaries must be on the lookout for “copay accumulator adjustment programs” that deny copay assistance from counting towards a patient’s annual deductible and out-of-pocket maximum.

The programs can increase patient drug costs by thousands of dollars at the pharmacy counter, leading to treatment abandonment.

“Choosing a health plan that best meets a patient’s needs is already hard enough, particularly at a time of rising deductibles and co-insurance,” said Carl Schmid, Deputy Executive Director of The AIDS Institute.

“Adding in copay accumulators, which are being implemented with little to no warning, will lead to sticker-shock at the pharmacy counter, and worse, treatment abandonment for patients who cannot afford increases in their drug costs by the insurance companies and PBMs.”

For more information on copay accumulator adjustment programs, here are some helpful resources: https://bit.ly/2PTgxYE