The following post is from Julie Baak, the Practice Manager for the Arthritis Center in Saint Louis, Missouri and a fierce patient advocate.
What is a Copay Accumulator?
Copay accumulator programs target the most costly specialty drugs. These drugs often have copay assistance programs in place to help offset costs to patients. A copay assistance program is where a drug company arranges for financial assistance to credit the patient’s account directly at the pharmacy counter. The goal of assistance is to help lessen the deductible burden and rising out of pocket costs for patients.
Beginning in 2018, insurers like United Healthcare (UHC) and Blue Cross Blue Shield, started crediting this assistance to the insurance company, often leaving patients stranded at the pharmacy counter unable to pick up their medication once their assistance award ran out.
Beyond the Pharmacy Counter
Now they want to take it beyond the pharmacy counter and into the doctor’s office. Beginning on January 1, 2021, UHC will take their copay accumulator policy a step further and also pocket the assistance of patients who receive infusions in their doctor’s office. This policy will affect many of those who receive infusion therapy, like patients with cancer, arthritis, AIDS, and multiple sclerosis.
UHC’s new Copay Accumulator Policy could financially ruin many of the most vulnerable patients. To be clear, this policy allows the insurance company to double dip and get paid twice. Once from the drug manufacturers copay assistance program and then again from our chronic disease patients. The best part is the new name: the Accumulator Adjustment Medical Benefit Program.
The operative word here is Benefit. A big benefit for UHC, and a slap in the face for many chronic disease patients like the ones we treat here at our offices in St. Louis.
What Will Happen?
Patients who are already dealing with chronic diseases often rely on manufacturers assistance programs to pay for their medicines. Without these programs, they simply will not be able to stay on therapy. With UHC’s new Accumulator Policy it will prohibit all assistance programs from counting towards the patient deductible and out of pocket expenses.
Simply put, many of our patients — and patients around the country — will not be able to stay on their therapy.
Crushing Patients Amid Record Profits
UHC has reported record profits for 2020, with their pharmacy business driving their growth. But they want more, and sadly they have made an internal decision that the best place to get it is off the backs of chronic disease patients. As you gear up for open enrollment, look closely at your plan and find out how this may affect you.
Several states have banned the use of copay accumulators with legislation, but often this does not help self-funded employer plans. Even if you live in a state with a copay accumulator ban — if your employer has implemented this practice — this ban does not help you. States that have enacted bans include: Arizona, Georgia, Illinois, Virginia, and West Virginia. You can follow states with active legislation via this map on our friends at Aimed Alliance’s website. Sadly, the state where our practice resides, Missouri, has not banned copay accumulators and we do not have any active legislation.
Threatens Health Outcomes for Patients
This policy threatens the health outcomes for millions of patients in the middle of a pandemic. Physicians are already burdened with excess paperwork. This increases that load and harms patients. And to top it off, UHC expects the physician’s office to deliver this new policy message to the patient, and then bill them for the difference. Click here to read the new policy.
Our office has reached out to the UHC provider representatives and the response has been the usual run around. Here is the drill:
- Call the phone number in the policy announcement letter;
- Get transferred around UHC; and finally
- Get told to email our representative — the one who originally told us to call the phone number in the letter.
We Opt Out
Our medical director will not be a part of this policy. After 27 years as a UHC rheumatology provider, we have made the decision not to do business with them. We informed UHC that we will be mailing letters to our patients on November 2nd with this message and have yet to receive a response.
An October Surprise?
It is hard to know if this is one of those UHC ‘October Surprise’ policies. They have a rich history of trying out devastating policies and then retracting them once patients and physicians complain. Our office has been stretched to the limit during COVID-19, so we must take all of these policies seriously and make internal changes accordingly. It would be great if one day they would consider their customers — patients — before making these policies.
There is a lot of talk about coverage for preexisting conditions. Both parties want that coverage. As someone who works with patients every day, I speak from experience when I tell you that implementing policies like these is discrimination against patients with preexisting conditions. Yes, they are covered, but they are no longer being cared for by this company.
What Can You Do?
Physician offices can let their voices be heard on social media, twitter, email and letters to UHC, legislators and advocacy organizations. several advocacy organizations have already sent a letter to UHC signed by 12 groups on 10/7/2020 but no UHC response has been forthcoming. Here is a link to that letter: Letter to United Health
Patients, please call your employers and educate them on what this UHC policy actually means to you and reach out to advocacy organizations such as Patients Rising by emailing: AskUsAnything@patientsrising.org or calling them at 800-685-2654. If you have been affected by a copay accumulator of any kind, please share your story at Patients Rising Stories.
It is a sad state of affairs that the health insurance that is supposed to protect our patients, is actively working against them.