16 states have banned a health insurance practice called “Copay Accumulators,” but it’s legal in California and can cost the chronically ill thousands every year.
The regulation was passed under the Trump administration and it legalized copay hoarders unless a state prohibited the practice. Now, a new bill just introduced in Sacramento could do just that.
Alyssa Dykstra was diagnosed with juvenile arthritis when she was very young. The autoimmune disorder causes painful, inflamed joints and fatigue, and his daily medication costs more than $11,000 a month.
“I’m very grateful to have insurance that makes this more reasonable,” said Alyssa Dykstra, a patient with a chronic illness.
She’s responsible for nearly $3,000 for a 28-day supply, which is still beyond the price most Americans can afford.
That’s why pharmaceutical companies have programs to help the chronically ill.
Alyssa Dykstra said: “Because they have contracted tariffs that they will get money from the insurance policy, they say ‘don’t worry about yourselves’, we’ll take what the company gives us and we were going to give you this coupon to subsidize your share out of pocket.”
But in California, insurance companies are entitled to what is called a “copayment accumulator.” Critics say it’s a way for insurance companies to make even more money on the most expensive prescription drugs.
“The way they did this is they told the consumer is that you can’t use the assist card to pay your annual deductible,” said Jerry Flanagan, Consumer Watchdog.
The chronically ill generally have high-deductible plans, which can be over $10,000. For Alyssa, her deductible is $3,000, which she wouldn’t have to pay every year without a copay accumulator. and due to his illness, money is scarce. she is on disability, as many chronically ill people are.
“Who benefits? Only the insurance companies because if the consumer pays more and the drug company helps, the insurance company’s costs go down and their profits go up,” said Jerry Flanagan, Consumer Watchdog.
“We try so hard and there are these systems put in place to exploit our diseases,” Alyssa Dykstra.
A California insurers’ trade association, the ACLHIC, says the real problem is exorbitant drug prices set by manufacturers and that co-pay coupons only fuel “out of control” prices.
They deny any claims of double dipping because they said the coupon price goes to the pharmacy, not the insurance company.