In the News

Observer: Using Prescription Coupons Might Be Raising Your Insurance Copay

Rhetoric counts. What’s in a name? The indication of what we want something to mean, to represent, to be. So, when it comes to insurance copays—to be or not to be, that is the question. And today’s question is, what is a copay maximizer?

Some readers will have heard about copay accumulators: a tool used by pharmacy benefit managers (PBMs) to punish patients who have the nerve to use prescription drugs by ensuring that manufacturer coupons don’t count towards fulfilling copay requirements. Accumulators are so perverse and pervasive that many states have already passed laws banning them and more legislation is undoubtedly on the way. (These pieces of legislation have had broad, bipartisan support. In the final week of March 2019, the governors of Virginia and West Virginia signed bills into law to curb accumulators, and Arizona passed a similar law on April 11, as did Washington on May 1.) Patient advocacy groups are lobbying lawmakers and petitioning state insurance agencies to review these PBM programs to determine whether they violate consumer protection rules.