Health plans are shifting more of the cost burden to patients through deductibles and coinsurance. As costs increase, patients may be forced to abandon their treatment. Third-party assistance helps patients with complex and/or high-cost conditions afford their medications and adhere to their treatment regimen, especially when no generic available. Since 2018, an increasing number of health plans have begun implementing policies often referred to as "copay accumulator adjusters" to prevent third-party assistance from counting toward a patient's out-of-pocket obligation, essentially negating any benefit to the patient. Imagine if a college accepted a $10,000 scholarship on behalf of a student, only to require the student to still pay the full cost of tuition because the $10,000 did not come out of the student's own pocket. With S.5299-A (Rivera)/A.1741-A (Gottfried), health plans will still get their money and patients will be able to better afford their care. Now is the time to address these policies and require health plans to allow third-party assistance to actually assist patients.

S.5299A/A.1741A Group Sign-On Letter

S.5299A/A.1741A Issue Summary

A.1741A Information

S.5299A Information

2021 AIDS Institute Report: “Double-Dipping: Insurance Companies Profit at Patients' Expense”