![]() Why are copay accumulator adjustment policies unfair? Patients unable to afford their medications face worsening health, disease progression, and the potential for significantly increased health care costs.Under copay accumulator adjustment programs patients believe they have reached their deductible only to learn that the copay assistance payments don’t count toward their deductible – leaving them with potentially thousands of dollars of unexpected medical costs in the middle of the plan year.Why are copay accumulator adjustments so bad for patients? ![]() When a patient receives and uses copay assistance, the health plan sweeps the payment from the copay assistance and does not allow it to be applied to a patient's deductible or out-of-pocket maximum resulting in patients facing large out-of-pocket costs.How does a copay accumulator adjustment work? However, insurers are using a new benefit design called copay accumulator adjustment that makes it more challenging for patients to afford their medication. A 2020 National Psoriasis Foundation survey of people with psoriasis and psoriatic arthritis found that 80.3% taking biologics with commercial insurance rely on copay assistance and 71% with incomes between $50,000 and $99,999 would be unable to afford their treatment without copay assistance.Ĭopay assistance programs can give patients suffering from cancer and other types of disease and chronic illnesses access to the lifesaving medication they may otherwise not be able to afford.A nationwide ACS CAN survey in February 2022 found that half of all cancer patients and survivors report incurring cancer-related medical debt, over 70% are worried about affording care, and women and Black Americans are most likely to experience cancer-related medical debt.Many New Yorkers face hardship when faced with medical bills, including prescription drug costs. Learn more about how UnitedHealthcare is helping members with diabetes.Proh ibit Copay Accumulator Adjustments-Pass A1741/S5299. This is why strategies to improve access and affordability are critical. Insulin is a lifesaving drug for people living with diabetes, but the high cost may put many diabetics at risk. Epinephrine (for severe allergic reactions).In addition to insulin, several other drugs used to treat emergencies, such as severe allergic reactions, hypoglycemia, opioid overdoses and acute asthma attacks will also be available for eligible members at a $0 cost share. “We always talked about this is how it should be for everyone,” he said. Radly said when he heard the news of the $0 copay benefit, he was ecstatic. “We are doing what we can to shield people from the prices set by pharmaceutical companies, and hope all stakeholders also will act to make prescription drugs more affordable.” “High prices are a significant barrier to prescription drugs for many people, so we are using our unique capabilities to deliver savings for consumers,” said Brian Thompson, chief executive officer of UnitedHealthcare. Earlier this year, UnitedHealthcare announced it will eliminate out-of-pocket costs in standard, fully insured group plans for certain preferred prescription drugs, including insulin. During 2023, more than 8 million members will have access to this his new standard offering. UnitedHealthcare is committed to helping members manage their chronic conditions, like diabetes, which includes access to certain prescriptions at $0 cost share. With more than 34 million Americans currently living with diabetes and 1.5 million diagnosed every year, there needs to be a solution to help more people have access to affordable insulin. For some, like Kimberly, price increases to insulin may be putting the drug out of reach or causing people to make difficult - sometimes unsafe - decisions.
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