New Resources Explain How Court Ruling Improves Insured Consumer Access to Medications

English and Spanish materials include information on a 2023 court decision that requires health plans to count copay assistance towards deductibles and annual out-of-pocket limits

WASHINGTON, DC / ACCESSWIRE / April 23, 2024 / The not-for-profit Aimed Alliance, in partnership with the Crohn's and Colitis Foundation, has produced and published new resources to help consumers understand how a 2023 U.S. District Court decision requires health plans to count copay assistance towards consumers' deductibles and annual out-of-pocket limits.

When patients cannot afford their medications, they may rely on financial assistance from pharmaceutical manufacturers to meet their health plan's cost-sharing responsibilities and fill their prescriptions. The value of this financial assistance typically counts toward the health plan's deductible or maximum out-of-pocket limit unless the health plan has implemented a copay accumulator program. Copay accumulator programs exclude the value of financial assistance from third parties from counting toward the health plan's deductible or maximum out-of-pocket limit. These programs may force patients to switch or stop taking their treatment because they cannot afford their out-of-pocket costs once their financial assistance has been exhausted.

In 2023, the U.S. District Court for the District of Columbia struck down a rule from the Department of Health and Human Services (HHS) that permitted copay accumulators. As such, all 2024 health plans are now required to count all copay assistance towards an individual's deductible and annual out-of-pocket limit. Plans are only permitted to exclude copay assistance when an individual takes a brand-name medication for which there is a medically appropriate generic alternative available.

"Unfortunately, accumulators are still being widely used by insurance companies and their pharmacy benefit managers," Ashira Vantrees, Counsel to Aimed Alliance, said. "It is now up to patients and their employers to stop the use of accumulators and the harm they cause."

"The Crohn's & Colitis Foundation is dedicated to supporting patients and in partnership with the Aimed Alliance, has developed new resources to navigate copay assistance and accumulators," said Laura Wingate, Executive Vice President, of Education, Support & Advocacy, Crohn's & Colitis Foundation. "These tools empower individuals to advocate for themselves, striving for equitable access to vital medications."

Direct links to the English and Spanish versions of the new resources are below:

FAQs: Court Decision on Copay Accumulators - English + Spanish

Copay Accumulators Are Banned: What Patients Need To Know - English + Spanish

Copay Accumulators Are Banned: What Employers Need to Know - English + Spanish

To learn more about copay accumulators and the recent federal court decision, visit Aimed Alliance's Copay Accumulator 101 page. Various other consumer resources are available for free on Aimed Alliance's CoverageRights.org website.

About Aimed Alliance

Established in 2013 and based in Washington, DC, Aimed Alliance is an independent, not-for-profit health policy organization that works to protect and enhance the rights of health care consumers and providers. For more information on Aimed Alliance and its initiatives, go to aimedalliance.org and follow @aimedalliance on X, Instagram, and Facebook.

About the Crohn's & Colitis Foundation

The Crohn's & Colitis Foundation is the leading nonprofit organization focused on both research and patient support for inflammatory bowel disease (IBD), with the mission of curing Crohn's disease and ulcerative colitis and improving the quality of life for the millions of Americans living with IBD. The Foundation's work is dramatically accelerating the research process, while also providing extensive educational and support resources for patients and their families, medical professionals, and the public.

Media Contact
Ashira Vantrees, Esq.
policy@aimedalliance.org

SOURCE: Aimed Alliance