The copay accumulator language was finally discovered on page 47 in a section called “Pharmacy Limitations and Exclusions” within a 144-page “Schedule of Benefits” document that is part of the plan contract. It took seven steps to find a reference to copay accumulators for Florida Blue, the largest private insurer in Florida. However, unlike a typical health insurance shopper, we were looking for specific language regarding the applicability of copay coupons basically, doing searches on certain words, something your average beneficiary would not even think of doing while searching for a health plan. The AIDS Institute began the search as if a prospective enrollee was shopping on. One plan representative indicated the policy is being implemented but still has not provided any written information to back it up. Finding the exact language required following a trail through multiple links and documents and was often found in documentation that is not available to a consumer until after enrolled in the plan. Implementation varied by issuer, with some being rather vague and unclear as to whether they were enforcing the policy consistently across all drug classes, selectively, or not at all.Īll plans buried the information, making it difficult to determine their policy. Through extensive research of plan documents and phone calls to plan customer service representatives, The AIDS Institute found that four out of six major insurers on the Florida marketplace had references to copay accumulator programs in their plan documents. This can lead to treatment interruptions that can impact a person’s health.įINDING THE COPAY ACCUMULATOR INFORMATION Without knowing that the plan they have been in will no longer count copay coupons towards their out-of-pocket spending can translate into unexpected prescription drug costs that can equal several thousand dollars in a single month. This helps consumers make informed decisions while they are selecting a plan, ensuring it best suits their medical needs and is affordable. Health insurers must present their health benefit design and patient costs in a transparent manner. The AIDS Institute discovered just how difficult it is to find and decipher the relevant information. In response, patient advocates are ringing the alarm, warning against the harm these copay accumulator policies will cause to beneficiaries and how difficult it is to determine if the plan they are in is implementing this new practice.Ĭoncerned by the impact copay accumulators will have on people accessing HIV and hepatitis C drugs, The AIDS Institute, based in Tampa, Florida and Washington DC, examined Florida’s qualified health plans to determine if and how plans were implementing these new policies. (See Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit.) This new practice prevents manufacturer copay assistance from counting towards a beneficiary’s deductible and maximum out-of-pocket spending. In January, Drug Channels kicked off the year by examining a new health insurance benefit design that has gained traction among pharmacy benefit managers and health plans called copay accumulator adjustment programs.
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