Write to your state-elected representatives before your out-of-pocket costs skyrocket for the same medications. 

States across the country are writing laws on this issue since insurance is regulated by the state (see footnote below). 

If your insurance company implements an accumulator program, your copay card's contribution, though still accepted at the pharmacy, will no longer go towards fulfilling your deductible and other out-of-pocket costs. More than 83% of people who have a commercial market insurance plan now have this accumulator provision. 

Some states have passed "all payments count" laws that ensure that copay assistance payments continue to count. 

Talking Points

• Health insurance is meant to protect us from high, unexpected medical costs. The accumulator provision does the opposite.
• Copay accumulator policies shift more costs to patients who have serious, complex, chronic illnesses.
• 21 states and Puerto Rico have enacted legislation that prohibits copay accumulator policies.
• Copay accumulator policies use complex language that is buried in the fine print of insurance policies.
• Health insurance companies profit by getting paid twice for the deductible copay
• There are no low-cost alternatives to the prescribed drugs used to treat many chronic diseases, including spondylitis.
• People have no choice. Not only are these new and costly accumulator provisions buried deep in the text of insurance policies, but in 14 states, every insurance policy has this provision. Most states have these provisions in the majority of insurance plans.
• Some legislators would like to address other changes to the healthcare system, such as transparency, generics, enticement coupons, premiums, Medicare, etc. Please remind legislators that this accumulator issue directly and adversely affects patients and needs to be fixed now. Conversations about other issues are fine to have, but support and pass this protection without confusion and delay.  
  
  Spondylitis Plus magazine explains Copay Accumulator Programs
  
  Sounds confusing? This is how one person in our community describes their experience: "Noticed this last year on Bluecross Blueshield of Texas Silver HMO. The copay accumulator program with my insurance plan takes the money from the copay assistance program for the first two monthly shipments of my biologic then in March and April it reduces my coinsurance in half which the copay card pays but the insurance credits those payments in March and April to my out of pocket, while it does not for Jan and Feb, and then from May to end of year my copays are zero for everything. It is weird. It is doing it again this year. No I haven't called the insurance company. Don't want to rock the boat. I do have cost sharing so they may not hit me with the full accumulator program because of that. It essentially reduces my maximum out of pocket amount by half. A regular copay accumulator program will not reduce it at all. The old style before copay accumulator programs would eliminate many people's out of pocket for the year. I am grateful for what slack they cut me because I know many people are struggling with these things. I don't know if it is my low income, government regulations or just the generosity of an insurance company (hahahahaha). It makes planning financially very unpredictable." 
   

State-by-State Status

Action Needed - These states have pending bills. If you live in these states, contact your elected officials and ask them to co-sponsor and vote for this. 
 

AK Click for a one-page fact sheet

AL: SB227 accumulator language was removed from the PBM transparency bill. 

CA: AB 2180 [updated 5/21/2024] was held in the Appropriations Committee. With a budget deficit this year, many bills were held, and, unfortunately, this legislation will not be moving forward this session. We will continue our fight for patient access and prepare for the next session. AB 2180 [updated 4/30/2024] passed the Assembly Health Committee 12-0. 

FL: HB1063  SB1480 [updated 1/7/22] . Past efforts: SB1078 & HB1111 were introduced in 2021, SB696 was introduced in 2019, postponed, and then died in Banking & Finance. [updated 1/7/2021]. Click for a one-page fact sheet to see which is the only insurer that doesn't have an accumulator provision.  

IA: HF2384 & SF2231 Passed House [updated 4/1/22].  Ask your elected representative to support it. Past efforts didn't make it to law: HSB 46/HF464/HF526 in drug pricing transparency bill. HF2551. Introduced 2/25/2020. 

MA: SD644 & HD3242 Passed out of committee. [updated 4/1/2022]. Past efforts did not make it to law: H926 & H928.

MD: HB0167 & SB0290 bills appear dead [updated 12/9/2021] . Was HB1360 &SB623. Please contact advocacy@spondylitis.org if you are willing to share your story of why CoPay Assistance is helpful.  Affordability Board has met and was asked to look into the copay accumulator issue. Legislatures need to hear from you [updated 8/20/2021]. 

MI: HB4353 passed House. Ask Governor to support it. [updated 4/1/22]. Past efforts: A 15 bill package has language in it making all co-pays count in Michigan [8/20/2021] 
 

MO: SB1031 sponsored by Senator Beck. First reading on 1/6/2022.  Additional cosponsors are needed. [updated 1/21/22]

MS: SB2470 & HB880. Please ask your elected representatives to support these and also let us know if you want to help champion up the issue.  

NC: We successfully have a law protecting assistance cards, however the insurance lobby is pushing hard to weaken it. With our coalition of patient groups in NC, we are sending letters to elected officials not to weaken the protection; they seem supportive and this come up for a vote in 2023. [updated 7/8/22]

NE: LB718 & LB767 introduced in 1/2022.[updated 1/7/2022]. Hearing scheduled on LB76 on 1/24/2022. LB270 within PBM transparency bill., this is stuck in committee [updated 12/9/2021].

NH: Hearing on health care reform at the beginning of September may include copay assistant cards. updated 9/4/20]

NM: HB 129 with rebate pass through and transparency bill. Passed the House and Senate; however unfortunately 'ran out of time' to be included in the calendar. Thank Rep Kelly Fajardo and Senator Daniel Ivey-Soto for their effort.  [updated 12/9/2021] 

NY: A1741 & S5299  Bills has passed both chambers - waiting for the governor to sign it. Past efforts:  A1741 & S5299 Bill went far, but fell short [12/9/21]A8246 & S6303. Passed both the Assembly and Senate. Send messages to Governor to sign it now, so that insurers don't try to detail the signing. [updated 7/8/22]

NV: SB171  was unanimously approved by the Senate Commerce and Finance Committee [4/13/2021]

OH: HB135 passed the House April 2022. Ask the state senate to pass it. Past efforts: HB469 not passed in 2020, we want it reintroduced in 2021. Legislatures are confusing this non germane issues. Partisan politics is making movement of any health bill difficult. Please remind them this is only about accumulator provisions.  [updated 10/1/21] . Our Ohio HB135 Coalition partner, the Ohio Bleeding Disorders Council is taking a leadership role on this effort. 

PA: SB196 & HB1664 Introduced as clean accum ban; amendments being negotiated - savings clause (ACCC language) and generics carve out including interchangeable biologics [updated 4/1/2022]. Past efforts: SB731 bill needs to be reintroduced for the new legislation in January 2021 [1/7/21]

RI: SB 2720 [updated 3/28/2024] The Senate approved legislation sponsored by Sen. Robert Britto (D-Dist. 18, East Providence, Pawtucket) that would improve prescription drug affordability for cancer patients and others with chronic diseases. -- H5438 & SB859 [updated 12/9/2021]. Past efforts: SB137 died. It needed accumulator language added back in. The bill committee recommended further study.

SC: H4987 Trying to get a hearing so that it will be on legislative agenda for 2023. Patient group coalition is meeting with legislatures to develop protections. The effort is spearheaded by the hemophilia patient group. [updated 4/1/2022]

SD: SB154 died [updated 12/9/2021]. Bill effort is led by the state medical association, considering language and seems to be leaning towards AS/GA bills. Please contact your representative to support the effort to create a ban on accumulators and to use the language from VA/WV bills. [updated; 1/7/2021]

UT: SB139 dead. Our coalition effort was led by a cancer organization and an AIDS organization [updated 4/1/2022].  

WI: The Assembly Health Committee did not have our bill on the schedule. This effectively kills the bills this session.  We are deeply disappointed in the lack of progress and are going to spend the next nine months educating candidates for the legislature on the importance of delivering these important patient reforms [updated 2/22/24]. SB215 & AB184 [updated 12/9/21]. Past efforts: SB907 failed to pass on 4/1/2020. Legislators need to hear real-life stories from patients about how this affects them.
 
VICTORY MAP

These states (& territories) have bills signed into law [on date] indicated below. No action is needed, other than a 'thank you' and defend challenges to the law:

1. AZ: H2166 passes and signed into law effective 12/31/2019 [4/11/2019]
2. AR: HB1569. Passed as ACT965, signed into law [4/27/21]
3. CO:  SB23-195 was signed into law by CO Governor Polis [6/5/2023]
4. CT: SB1003. Passed and signed into law effective 1/1/2022. [6/2/2021]
5. DE: SB267 passed and signed into law  effective 01/1/2024 [10/26/22]
6. GA: HB946 / SB313 passed and signed into law effective 7/1/2021 [8/5/2020]
7. IL: H465 passed and signed into law [8/23/2019] *** However, insurance companies are now trying to pass a law to remove it and also DOI memos to negate it***
8. IN: HB1252 was signed into law [5/8/2025]
9. KY: SB45 passed and signed into law effective 1/1/2022 [3/2021]
10. LA: SB94 passed and signed into law [updated June 2021]
11. ME: LD1783 & SP621 passed and signed into law [5/7/2022]
12. NC: SB257 passed & signed into law [5/19/2021]
13. ND: HB 1216 passed and signed into law by Governor Armstrong [4/30/2025]
14. NM: SB51 was signed into law by Governor Lujan Grisham. [3/18/2023]
15. NY: passed both houses. Waiting for the Governor to sign it.
16. OK: SB92 / HB2678 passed and signed into law effective 11/1/2021 [4/19/21]
17. OR: HB4113 passed and was signed into law [3/27/2024]TX: HB999 passed and was signed into law [6/10/2023]
18. TN: HB619 / SB1397 passed and signed into law effective 7/1/2021 [5/12/2021]
19. TX: Texas passed a copay law on June 10, 2023, with Governor Greg Abbott signing House Bill 999 into law. 
20. VA: H2515 / SB1596 passed and signed into law effective 1/1/2020 [3/21/2019]
21. VT: Vermont passed its copay accumulator law, specifically Senate Bill 233, on May 30, 2024. 
22. WA: HB1713 & SB5610 passed and signed into law effective 1/1/2023 [3/30/2022]
23. WV: H2770 passed and signed into law effective ~6/10/2019 [3/9/2019]
24. Puerto Rico
25. DC: The D.C. Council passed the Copay Accumulator Amendment Act, now D.C. Law 25-26, on May 2, 2023. 
    
    ---------------------------- 
    Footnote: [updated 1/31/2020] A coalition of patient advocacy groups has been working on a federal fix. Unfortunately, our first read of the proposed rule by Centers for Medicare & Medicaid Services (CMS) '2021 Notice of Benefit & Payment Parameter', is not a win for patients. CMS leaves it to the discretion of issuers as to whether or not to count copay assistance toward a patient's deductible and out-of-pocket costs, even in the case when there is no medically appropriate, generic equivalent available. Link to the rule's fact sheet https://www.cms.gov/files/document/proposed-2021-hhs-notice-benefit-and-payment-parameters-fact-sheet.pdf. Stay tuned for more information.
    
    Thank you to the AIDS Institute for sharing the State map and for the thoughtful report and 1-Pager State Fact Sheets.