For many, January 1 marks the beginning of a new term with their health insurance plans. This year, be on the lookout for a new insurance tool that is rising in popularity—the copay accumulator program. In response to escalating prescription drug costs, insurers and employers are implementing accumulator programs that could hinder the ability of patients to access their medications. Patients who cannot afford their copayments or coinsurance may be able to obtain a finite amount of assistance from drug manufacturers in the form of “copay coupons.” Historically, these coupons have contributed toward a patient’s deductible. However, copay accumulator programs prevent assistance from contributing towards the patient’s deductible. As a result, the insurer receives both the value of the coupon intended for the patient as well as the full deductible amount from the patient—essentially a “double-dip.” These programs are especially problematic for patients who need high-cost medications and have relied on copayment assistance to fill their prescriptions. They are often unaware of changes to their health plans, and therefore, once assistance runs out, they are stuck with an unexpectedly high bill at the pharmacy counter. Patients could be blindsided when they discover they are still in the deductible phase of their health plans when they expected to have already reached the coverage phase. A new report from Aimed Alliance, a not-for-profit organization that works to protect and enhance the rights of health care consumers and providers, explores the legal and health risks that these programs present. Employers Beware: Understanding the Costs and Liability Risks of Health Insurance Copay Accumulator Programs finds that copay accumulator programs can result in discrimination and can violate both state and federal consumer protection laws. The report offers recommendations for how these programs can be structured to ensure that patient access to medications is not unnecessarily disrupted. Aimed Alliance also has developed a brief fact sheet on these programs. Aimed Alliance expects these accumulator programs to continue proliferating across the country. According to a 2018 survey from National Business Group on Health, 56 percent of employers reported considering adopting a copay accumulator program in 2019 or 2020. Yet, no state prohibits or regulates them. Women legislators play a vital role in protecting consumers from predatory practices. Aimed Alliance is available to provide technical assistance to help legislators raise awareness about copay accumulators and propose legislation to regulate their use. | 
