AIDS Group Says ACA Plan Copay Accumulators are More Common Than Not

MHE Publication, MHE May 2021, Volume 31, Issue 5

Copay accumulators are a common feature in health insurance plans sold on the ACA exchanges, according to a recent report from an AIDS advocacy group that wants the Biden administration to reverse a decision made by the Trump administration that allowed continued use of accumulators.

Copay accumulators are a common feature in health insurance plans sold on the ACA exchanges, according to a recent report from an AIDS advocacy group that wants the Biden administration to reverse a decision made by the Trump administration that allowed continued use of accumulators.

The AIDS Institute issued a report in March that says that at least two-thirds of the ACA health plans in 35 states include a copay accumulator and that in 14 states, every plan does.

Copay accumulators remove any copay assistance that members receive from spending that would count toward a health plan’s deductible. Patient advocacy groups say accumulators undermine copay assistance and protection against the high cost of drugs. And the AIDS Institute says in its report that they doubly benefit insurers and PBMs because they receive the copay assistance funds and then the amount the member spends until the plan’s out-of-pocket maximum is reached. The counterargument from insurers and PBMs is that accumulators sabotage formularies and wind up making healthcare and premiums more expensive.

Last year, the Trump administration moved to limit accumulators and then reversed course. The AIDS Institute wants the Biden administration to change the Trump administration’s policy and rein in the use of accumulators.