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
Texas is one of twenty states, plus the District of Columbia and Puerto Rico, that bans copay accumulators.
That's according to an analysis of National Conference of State Legislatures data by Austin News.
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.
Texas requires 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
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