Guest Author
In the United States, health care spending in 2021 averaged almost $13 thousand per person.
Luckily, charitable programs and coupons exist to make it easier for patients to afford their necessary treatments and medications.
Unfortunately, a little-known but now commonly used language known as a copay accumulator prevents assistance funds from counting toward a patient’s deductible/out-of-pocket maximum.
Copay accumulator programs have a negative impact on the economy, particularly for patients who are already struggling to afford their health care. This policy has significant implications for individuals and families, particularly those in already vulnerable populations.
Copay accumulators place a financial burden on patients who are already struggling to afford health care. Patients may be forced to forgo necessary medications or delay treatment because they simply can’t afford it, which can have long-term health consequences and lead to increased health care costs down the line. In 2019, 1 out of 4 Americans delayed treatment for a serious medical condition due to cost.
Vulnerable populations, such as the Hispanic community, are more dramatically impacted by the effects of copay accumulator programs. Members of the Hispanic community are more likely to have lower household income than their non-Hispanic white counterparts. Copay accumulators exacerbate this existing issue by making it more difficult for individuals to afford their necessary medications. This is likely to lead to reduced medication adherence, poorer health outcomes, and increased health care costs down the line.
When patients cannot afford their prescribed medications, this has a ripple effect on the larger health care ecosystem, and subsequently a negative impact on the U.S. economy. Research and development companies rely on a profitable market to reinvest in medical research and development. Copay accumulator programs make it more difficult for companies to sell their products, especially when patients cannot afford their prescriptions and are forced to turn to lower-cost alternatives.
It is unfortunate that copay accumulators are just one example of a health care practice that harms patient access as well as the economy and innovation. Another example is the process that drug rebates and discounts are processed, which fail to reach patients at the point-of-sale and instead are pocketed by insurance companies and health care middlemen.
Banning copay accumulators and implementing rebate reform are simple steps that policymakers can take to ensure patients can access affordable, innovative treatments and medications when they need them. At the national level, Florida’s Congressional Delegation is working to ban copay accumulators through the Help Ensure Lower Patient (HELP) Copays Act. And at the state level, Gov. Ron DeSantis has championed the issue of lowering prescription costs for patients, and Sen. Tom Wright has introduced Senate Bill 46 to ban copay accumulator practices in Florida. In fact, the Senate Banking & Insurance Committee recently unanimously passed it due to the passion and leadership of Sen. Wright.
Florida’s state legislators should support these patient-first policies and include a ban on copay accumulators and rebate reform at the point-of-sale in the PBM legislation the state is currently considering.
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Liliam M. Lopez is the president and CEO of the South Florida Hispanic Chamber of Commerce.
