Virginia first in nation to protect patients from insurance tactic undermining access to care

Fair Health Care VA today applauded Gov. Ralph Northam for signing House Bill 2515, which will protect patients from a new insurance practice called copay accumulator adjustments, into law this week.

As the cost of health care continues to increase, manufacturers have implemented copay assistance programs, providing copay cards or coupons to defray the cost of care that patients need. But a new insurance tactic known as “copay accumulator adjustment programs” seeks to deny patients this benefit by refusing to count the value of copay assistance toward a patient’s deductible. As a result, patients have begun arriving at the pharmacy counter expecting to pick up their medication, only to find out they have to pay out-of-pocket, sometimes thousands of dollars, before they can receive the care they rely on.

“As out-of-pocket costs continue to rise, Virginia patients already face enough barriers to accessing the health care coverage that they need. Copay assistance programs are a critical resource, particularly for patients whose health care costs could bankrupt their families or force them to live without the care they need,” said Dr. Bruce A. Silverman, a Richmond nephrologist and advocate for the Fair Health Care VA Coalition. “Patients should not be denied one of the key benefits of copay assistance programs, particularly since insurers are already getting the value of negotiated drug price discounts while withholding these benefits from patients.”

HB 2515 requires that any payments made towards a patient’s cost of care – including what a patient pays out-of-pocket and any copay assistance – count towards their overall out-of-pocket maximum payment or deductible. With nearly 1 in 5 major employers already using copay accumulator adjustment programs, and with more expected to follow, this new law is both critical and timely.

“Hemophilia patients, and others with chronic conditions, often rely on copay assistance and cannot afford to pay thousands of dollars at the pharmacy counter before they can get the medication they rely on,” said Kelly Waters, executive director of the Virginia Hemophilia Foundation. “I am proud to see Virginia leading the nation in addressing this issue for our patients.”