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Sunday, June 16, 2024

California one of 30 states that allows copay accumulators

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Tim Storey, CEO, National Conference of State Legislatures, left, and Julie Gull Sheffield, Patients Come First | NCSL.org / PatientsComeFirst.com

Tim Storey, CEO, National Conference of State Legislatures, left, and Julie Gull Sheffield, Patients Come First | NCSL.org / PatientsComeFirst.com

California is one of thirty states that allows copay accumulators.

That's according to an analysis of National Conference of State Legislatures data by Golden State Today.

A copay accumulator is a program used by some health insurers in the United States that does not count copay assistance payments toward a patient's deductible or out-of-pocket maximum.

California does not require insurers to count all payments made by patients, even those from patient assistance programs, toward the patient’s out-of-pocket maximum.

Opponents of copay accumulators, such as Bridget Tyrey, executive director of the Gateway Hemophilia Association (GHA) in St. Louis, Mo, say that copay accumulators cause patients to “basically pay twice, first with their copays assistance card, second from the patient."

While some health insurers say copay accumulator bans would result in higher insurance premiums, a May 2023 analysis by The AIDS Institute found "no evidence that enacting a copay accumulator adjustment ban has a meaningful impact on average premiums." That analysis looked at 16 states that banned CAAPS between 2019 and 2022.

Julie Gull Sheffield, who works with the group, Patients Come Firs,, said that copay assistance is a “critical resource” to provide patients the “assistance they need to access medications,” but that “often copay accumulators are used to block those discounts from helping patients by not allowing it to count toward a patient’s deductible and out-of-pocket maximums.”


Which states ban copay accumulators?

Source: National Conference of State Legislatures

State NameBan on Copay Accumulators?
AlabamaNo
AlaskaNo
ArizonaYes
ArkansasYes
CaliforniaNo
ColoradoYes
ConnecticutNo
DelawareNo
District of ColumbiaYes
FloridaNo
GeorgiaYes
HawaiiNo
IdahoNo
IllinoisYes
IndianaNo
IowaNo
KansasNo
KentuckyYes
LouisianaNo
MaineYes
MarylandNo
MassachusettsNo
MichiganNo
MinnesotaNo
MississippiNo
MissouriNo
MontanaNo
NebraskaNo
NevadaNo
New HampshireNo
New JerseyNo
New MexicoYes
New YorkYes
North CarolinaYes
North DakotaNo
OhioNo
OklahomaYes
OregonNo
PennsylvaniaNo
Rhode IslandNo
South CarolinaNo
South DakotaNo
TennesseeYes
TexasYes
UtahNo
VermontYes
VirginiaYes
WashingtonYes
West VirginiaYes
WisconsinNo
WyomingNo

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