11/11/2023 0 Comments Otezla copay savings card![]() ![]() ![]() As more and more patients move into high-deductible health plans, this concern is exacerbated.Įspecially egregious is that health plans and pharmacy benefit managers (PBMs) are effectively ‘double dipping’ with this new practice, accepting payment equal to double the full value of a patient’s deductible before they consider it to be met.Īn analysis by the health care consulting firm Zitter Health Insights found that approximately 12% of patients in the commercial space are subject to accumulator programs, while 44% of commercial plans have the program in their language. This will make it significantly more difficult for patients to meet their annual deductibles. The $95 paid by copay assistance does not count toward the deductible. However, if a patient’s health plan is using an accumulator adjustment program, only the $5 paid directly by the patient would be applied toward the deductible or out-of-pocket maximum. In the past, all $100 would be applied toward that patient’s deductible and/or their out-of-pocket max. However, they do change what “counts” toward the patient’s deductible. ![]() Using copay assistance, a patient might pay $5 for the prescription, while the remaining $95 would be covered by the co-pay assistance program. SchweitzĬonsider a prescription that would normally cost a patient $100 out of pocket to fill at the pharmacy. As explained below, accumulator programs are a change to the way insurers count the value of copay assistance for the purpose of calculating whether a patient has met their deductible or out-of-pocket maximum for the year. Q: What are copay accumulator programs?Ī: Copay accumulator programs, also called accumulator adjustment programs, are a new utilization management tool being implemented by pharmacy benefit managers and health plans that exclude copay assistance from counting toward a patient’s deductible or other out-of-pocket maximum.Ĭopay assistance programs help patients with the out-of-pocket costs of deductibles, coinsurances and copays however, this assistance is not unlimited and is often exhausted by mid-year. Schweitz, MD, tackles reader questions on a range of health policy topics and the impact of health care reform on daily rheumatology practice. If you continue to have this issue please contact to Healio ![]()
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