That is, the drug manufacturers would cover all or a portion of the participant’s deductible and copayment or other required cost-sharing under the plan (sometimes up to a specified dollar amount), and the manufacturers’ payments would count toward the participant’s satisfaction of the plan’s deductible and cost-sharing limit. Traditionally, this financial assistance reduced the participant’s cost-sharing under the plan. Prescription drug manufacturers sometimes offer financial assistance to individuals for certain drugs to help defray costs that might otherwise be an impediment to obtaining the drug (potentially resulting in a lost sale for the manufacturer). Here is how a typical copay accumulator program works: The term “copay” is a bit misleading because these programs may also provide deductible and other cost-sharing assistance. Can we still have one?ĪNSWER: Some plan sponsors have implemented “copay accumulator” programs in connection with the prescription drug coverage under their health plans. We’ve heard that the agencies have restricted the use of these programs. QUESTION: Our group health plan uses a copay accumulator program that does not count drug manufacturers’ financial assistance toward participants’ cost-sharing limits.

Copay accumulator