Golden State Today

An official from the Hemophilia Council of California advocates that state lawmakers should approve a future ban on a program used by some health insurers in the United States, which does not count copay assistance payments toward a patient’s deductible or out-of-pocket maximum.

Lynne Kinst is the Executive Director of the Hemophilia Council of California, one of five organizations which had co-sponsored Assembly Bill 2180 – legislation which would have served to ban the above patient payment framework, known as copay accumulators.

Despite a plethora of external support from health care-focused advocacy organizations and health care providers, the bill did not emerge from its committee process.

Kinst outlined why the Hemophilia Council is opposed to the practice of copay accumulators.

“We believe California should ban copay accumulators because these policies prevent financial assistance from counting towards a patient’s deductible and out-of-pocket maximum. This increases the financial burden on patients, who already face high costs, as they must pay more out-of-pocket before reaching their deductible, leading to potential treatment delays and decreased adherence to their necessary medical needs. And the patients who use financial assistance programs need them – 69% of patients who receive assistance earn less than $40,000 per year,” Kinst told Golden State Today.

This practice further levies steep financial burdens and a detriment to the quality of life for hemophilia patients, Kinst explained.

“Copay accumulator policies significantly increase the financial strain associated with managing a complex condition. Hemophilia treatments are costly, and without the support of financial assistance counting toward out-of-pocket limits, patients face prohibitive expenses. This often results in skipped or reduced treatment, which negatively affects their health and quality of life,” said Kinst.  

Though AB2180 did not make it out of committee, Kinst said its supporters remain determined to get the legislation passed in the next annual session.

“Assembly Bill 2180 garnered significant support from patient advocacy groups, providers and health care organizations, but unfortunately died in [the] Committee [on Appropriations]. We are still committed to seeing this passed in California, though, and will try again next year,” said Kinst.  

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 First 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.”

Alongside the Hemophilia Council of California, the ALS Association, California Rheumatology Alliance, Cystic Fibrosis Research Institute and the Sickle Cell Disease Foundation had co-signed AB2180, in the hopes that patients who may otherwise face severe financial burdens under a copay accumulator, would have a reprieve.

California currently 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.

Currently, 21 states, Washington, D.C. and Puerto Rico have passed laws mandating that health insurers count the value of copay assistance towards a patient’s cost-sharing responsibilities, including Arizona, Arkansas, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, New Mexico, New York, North Carolina, Oklahoma, Oregon, Tennessee, Texas, Vermont, Virginia, Washington and West Virginia.

Which states ban copay accumulators?

Source: National Conference of State Legislatures

State Name	Ban on Copay Accumulators?
Alabama	No
Alaska	No
Arizona	Yes
Arkansas	Yes
California	No
Colorado	Yes
Connecticut	Yes
Delaware	Yes
District of Columbia	Yes
Florida	No
Georgia	Yes
Hawaii	No
Idaho	No
Illinois	Yes
Indiana	No
Iowa	No
Kansas	No
Kentucky	Yes
Louisiana	Yes
Maine	Yes
Maryland	No
Massachusetts	No
Michigan	No
Minnesota	No
Mississippi	No
Missouri	No
Montana	No
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	No
New Mexico	Yes
New York	Yes
North Carolina	Yes
North Dakota	No
Ohio	No
Oklahoma	Yes
Oregon	Yes
Pennsylvania	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	Yes
Texas	Yes
Utah	No
Vermont	Yes
Virginia	Yes
Washington	Yes
West Virginia	Yes
Wisconsin	No
Wyoming	No