In a victory for patients, a federal judge recently struck down a policy that allowed health insurance plans to use copay accumulator and maximizer programs, thereby charging patients more for essential prescription medications.

This is good news for those who live with myositis and want to use a manufacturer’s assistance coupon to help them afford their medications. Copay accumulator and maximizer programs don’t allow patients to count these discounts towards their deductibles. This increases out-of-pocket costs and could make it impossible for some patients to access the life-saving treatments they need. 

The effort to overturn this policy was led by patients and patient advocacy organizations who brought legal action, claiming copay accumulator programs caused them harm. The ruling is great news for patients and is a great example of the power of the patient’s voice to overturn unfair and discriminatory policies.

According to HIV+HEP Policy Institute, one of the advocacy organizations involved in the suit, “By using copay accumulators, health insurers pocket copay assistance patients receive, rather than allowing it to assist patients in paying for their necessary medication.”

As a result of this effort, health plans are now only permitted to use copay accumulators for branded drugs that have a generic equivalent, and only if it is allowed by state law. Most manufacturers provide assistance programs only for drugs that do not have a generic equivalent anyway, making it more likely that the discount will count toward your deductible. This is now federal law, effective immediately, for all commercial plans, including ERISA and exchange plans. 

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