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‘Copay Accumulator’ Bill Sees Action in Colorado Legislature

By May 3, 2023May 5th, 2023eMS News

Many insurance companies have recently begun implementing “Co-Pay Accumulator Adjustment Programs,” which prevent third-party financial assistance, such as patient assistance programs, from applying to a patient’s insurance deductible or other out-of-pocket costs.

As a result, these accumulator adjustment programs increase out-of-pocket costs for patients and make it difficult for individuals with high deductibles or chronic diseases to follow treatment plans. Additionally, insurance companies often use complicated or confusing language when describing these adjustment accumulators, which can make it difficult for consumers to recognize them in their insurance plans.

Fortunately, a bill currently in the Colorado State Legislature (SB23-195) would ensure patients receive the full benefit of co-pay assistance programs by requiring all payments made by or on behalf of an insured to count towards their out-of-pocket cost-sharing requirements.

If you are a Colorado resident, we invite you to join the MS Center and other advocates for chronic disease care in supporting this legislation by writing an email to your State Senator. Click here to make your voice heard, and please be sure to customize the sample letter (your unique story is much more likely to get their attention than a form letter).

UPDATE —  from the Chronic Care Collaborative on Friday, May 5, 2023:

Great news! SB23-195 has passed the legislature with strong bipartisan support from both chambers! We need your help to contact Gov. Jared Polis to ask for his signature and explain why legislation is important to you and your community.

As the chronic disease community knows well, many patients rely on third-party financial assistance to pay for their high-cost medications or cover their out-of-pocket costs before reaching their deductibles.

Insurance companies have stopped counting third-party financial assistance towards a patient’s deductible and out-of-pocket maximum, making it much harder for patients to afford their medicine and stick to a treatment plan.

Six in 10 patients and caregivers say they would have extreme difficulty affording their treatments and medications without copay assistance programs being applied to their out-of-pocket costs.

These misleading policies harm Coloradans in many ways. When someone cannot afford their medication, they are more likely to abandon their treatment altogether, which can led to even worse health outcomes.

Colorado has just become the 18th state to pass legislation banning insurance policies that prevent critical financial assistance from counting toward a patient’s out-of-pocket costs. All we need in Colorado now is the Governor’s signature.

No Coloradan should face barriers to life-saving medication because of misleading insurance policies that make their medicine more expensive than it should be.

Will you join us in writing an email Governor Polis? Click here to make your voice heard! Be sure to customize the sample letter (your unique story is much more likely to get their attention than a form letter!).

 

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