![]() On a state level, legislation has been enacted in Virginia, West Virginia, Illinois, Arizona and Georgia.Specifically, the Arthritis Foundation has led and/or has been involved in efforts to educate legislative leadership in all 50 states as well as all 50 state insurance commissioners.The Arthritis Foundation sits on the steering committee for the ACCC and co-chairs the state subgroup. The All Co-pays Count Coalition (ACCC) was formed to provide a collaboration amongst the patient and provider community around legislative and patient education efforts on a federal and state level.*Source: American Journal of Managed Care, Impact of a Co-pay Accumulator Adjustment Program on Specialty Drug Adherence In another recent employer survey, 54% of respondents did not credit third-party co-pay assistance toward patient deductibles.* In a recent survey of employers, nearly 30% implemented a CAAP for 2019 and 21% were contemplating one for 2020 or 2021.Among these individuals, 59% reported that they can use it to pay for their deductibles, 27% reported they can’t use it for their deductible and 14% reported that they don’t know. 39% of patients on an employee-sponsored health plan used a drug manufacturer co-pay card to help pay for their arthritis medications.When faced with that unexpected charge, 24% of patients said that they did not fill their prescription, and 8% of patients said they did not take their prescription as prescribed. 84% said that a large, unexcepted charge for a prescription drug would impact their overall budget.In an Arthritis Foundation survey of more than 600 patients, we found that:. ![]() HDHPs have become increasingly popular as employers and insurers seek opportunities to incentivize appropriate health care utilization and to lower costs. People most likely to be enrolled in co-pay accumulator adjustment programs include those with employer-sponsored insurance plans, particularly individuals enrolled in high-deductible health plans (HDHPs).As a result, when you go to refill your prescription in April, you will owe $3,000, the full cost of your drug, because the deductible has not yet been paid down. By the time March arrives, you’ve reached the limit on your co-pay assistance. You use your co-pay card at the pharmacy and make a regular co-payment at the counter. Example: It’s the start of a new health plan year in January and you are on a biologic with a list price of $3,000 a month.These programs can be called different names, are often marketed as a positive benefit, and are often disclosed many pages into plan materials, leading to a lack of awareness about them to patients. Patients are often unaware they are enrolled in one of these programs until they go to the pharmacy counter and realize they must pay the full cost of their medication, which can lead them to abandon or delay their prescription.With an accumulator adjustment program, patients are still allowed to apply the co-pay card benefits to pay for their medications up to the full limit of the cards, but when that limit is met, the patient is required to pay their full deductible before cost-sharing protections kick in. Traditionally, pharmacy benefit managers have allowed these co-pay card payments to count toward the deductible required by a patient’s health insurance plan. Many pharmaceutical manufacturers offer co-pay cards that help cover a patient’s portion of drug costs.Accumulator adjustment programs prevent any co-payment assistance that may be available for high-cost specialty drugs from counting toward a patient’s deductible or maximum out-of-pocket expenses.I am a Federal employee & our coverage has been deteriorating over the years to the point of co-pay started at $5 & is now $15 for Dr visit & up to $30 for prescription. You might ask before joining how much their premiums have gone up recently. Not that I don't like the convenience but if you add a 50% increase in monthly premiums to the cost of prescriptions, the co-pay hurts more than it used to. I missed the cut off date or I would have gone with another. The caution I would throw your way is that Kaiser just increased in my premiums monthly 49% this past calendar year. But just to agree with most everyone here it is defintely available through Kaiser. So I just started with Soriatane, not quite 3 weeks yet & it hasn't started working at all. I have been with Kaiser WA State for over 15 years & last I spoke with my derm he said Enbrel is not a problem for availability, but he was cautious as it is a relativley new treatment.
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