Federal | Ensure All Copays Count!
A bill was recently introduced that will help patients afford their medications by ensuring that any copay assistance counts toward their out-of-pocket costs. The Help Ensure Lower Patient (HELP) Copays Act (S.864) is a two-part solution that curbs a growing practice called "accumulator adjustment programs" that prevent copay assistance (such as a copay card through a manufacturer) from counting towards your overall out-of-pocket costs. Meaning once your copay assistance runs out, you must pay your full deductible and annual out-of-pocket requirement to access your medication. 

The bipartisan HELP Copays Act requires health plans to count the value of copay assistance toward patient cost-sharing requirements. This would bring much-needed relief to arthritis patients by ensuring that all payments—whether they come directly out of a patient’s pocket or with the help of copay assistance—counts towards their out-of-pocket costs. 

Do you know if your health plan has a copay accumulator? Take a few moments to check!

1. Review Your Health Plan: Review the language in your health plan's documents. These programs may be called "Coupon Adjustment: Benefit Plan Protection Program,"  "Out-of-Pocket Protection Program," or “Copay Leveling Program.”

2. Personalize your Message: Include what you find in your message to your Legislator! Does your plan have an accumulator? Were you unable to find anything about it at all? Let them know how this affects you!

Learn more about Accumulator Adjustment Programs in this Policy 101 video!

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