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Co-pay accumulators
Prescription medications can be super expensive , so it ’ s a good thing that there are assistance programs available to help patients cover some of the costs . Assistance is often provided by charities , nonprofits , or drug manufacturers , and is designed to offset the cost of treatments and medications . The only catch is that there are now other programs in place that seem to negate any of the benefits that the assistance programs provide . If it sounds confusing , that ’ s because it kind of is , but the simplest explanation is this : Pharmaceutical companies , and other organizations , often offer programs to offset the high cost of medications . The programs are known as copay assistance programs , or sometimes coupon programs or co - pay savings programs .
The extra costs often prevent patients from using specialty therapies or following the doctor recommended treatments . STUDIES INDICATE THAT THE RESULT OF COPAY ACCUMULATOR PROGRAMS IS POORER HEALTH OUTCOMES AND POSSIBLE HIGHER COSTS TO THE HEALTHCARE SYSTEM.
OVER HALF OF INSURERS BELIEVE THESE PROGRAMS CAN DETER PATIENTS FROM TAKING THEIR MEDICINES AS PRESCRIBED
50%+
60% OF INSURERS STRONGLY AGREE THAT ACCUMULATOR ADJUSTMENT PROGRAMS CAN SHIFT COSTS TO PATIENTS
Since arriving on the scene , the copay accumulator programs have been controversial . Patient advocacy organizations say the accumulator programs are unfair . Organizations such as the Immune Deficiency Foundation ( IDF ) have noted that it doesn ’ t make sense that the source of the payment for the medication should matter . The best way to find out if a plan contains a copay accumulator or maximizer program is to call the insurance provider ’ s customer service number and ask them directly . Be sure to specifically ask whether or not the plan prohibits third party ( manufacturer , charity , or nonprofit ) contributions from counting toward the deductible and out - of - pocket costs .
LINK TO EXTENDED BLOG
https://catalyst.phrma.org/new-data-from-insurers-show-detriments-of-copay-accumulator-adjustment-programs
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