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- Copay Accumulator and Maximizer Update: Adoption Expands as Legal . . .
Our latest update finds that as of late 2023, about half of commercial lives were in plans that utilize a copay accumulator and or a maximizer These programs’ growth continues to divert the value of a manufacturer’s copay support payments away from patients and toward plans and PBMs
- State Copay Accumulator Bans Now Affect 16% of Commercial Lives
As of March 2025, 21 states have enacted laws banning payer and PBM use of copay accumulator programs These laws apply to state-regulated health plans, including the individual, fully insured large-group, and small-group markets (see Figure 1)
- 2024 Copay Accumulator Maximizer Programs - Crohns Colitis Foundation
Discover how copay accumulator and maximizer programs can impact your out-of-pocket costs for IBD medications and what you can do about them
- Federal Court Strikes Down Copay Accumulator Programs
On September 29, 2023, the U S District Court for the District of Columbia vacated a Trump-era rule from 2021 that allowed insurers to exclude drug manufacturer co-pay support coupons and assistance from a patient’s annual cost-sharing caps
- Copay Accumulator And Maximizer Programs: Stakes Rise For Patients As . . .
In September 2023, patient advocacy organizations secured a legal victory against these programs in federal court, which reinstated a federal rule requiring insurers to count manufacturer
- 2023 Update: Six Years of Deductible Accumulators and Copay . . . - IQVIA
Since 2017, IQVIA has tracked and reported on deductible accumulator and copay maximizer plans While accumulators exclude manufacturer-sponsored copay support from counting towards a patient’s deductible, maximizers are designed to exhaust the annual assistance benefit available from manufacturers
- What you need to know about copay accumulators and maximizers
Copay maximizers allow plans to “maximize” the value extracted from copay assistance programs by adjusting a patient’s cost-sharing to the maximum amount of available assistance and not allowing the funds to count toward the patient’s deductible or out-of-pocket costs
- State Copay Accumulator Legislation: An Overview
As of June, 21 states have implemented copay accumulator bans with varying scopes and provisions In a bolder move, Nevada announced at the end of May that it will enforce the Circuit Court’s ruling in health plans in the state
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