The AACU is advocating in Ohio for HB 135 – legislation that would require insurers and pharmacy benefit managers to count all payments made on behalf of a beneficiary to their deductible and out-of-pocket maximums for prescription medications. Payers are increasingly shifting their fiduciary responsibility onto patients by a variety of means
including poor plan design and mid-year formulary changes, significantly increasing deductibles, copayments, coinsurance, and creating specialty-tier formularies and specialty pharmacies.

Third-party copay assistance funds are intended to help patients afford and adhere to their medication. When payers utilize copay accumulator adjustment programs, patients experience the following:

  • Copay accumulators discriminate by forcing high-risk patients off medications.
  • 99.6% of all medications which receive third-party copay assistance have no generic options.
  • Copay accumulator programs lead to higher costs for patients, forcing them to choose between treatments and other expenses such as rent, nutrition, and other family expenses.
  • Patients who stop using their medications due to high costs end up having more emergency room visits and negative health outcomes, which increases overall health care costs.

The AACU is advocating for co-pay accumulator legislation in many states in upcoming legislative sessions. Please reach out to Kristin Jimison for more information.