Many arthritis patients use co-pay assistance, such as co-pay cards or manufacturer assistance, to pay for their life-saving medications. Pharmacy benefit managers (PBMs) and insurers increasingly use co-pay accumulator programs to prevent assistance from counting towards patient cost-sharing, such as their deductible or annual out-of-pocket maximum. As a result, patients may struggle to afford and adhere to their medications as insurers and PBMs seek to shift more cost-sharing responsibility to patients. This legislation is important to patients and breaks down barriers to care for people living with arthritis.