Copay accumulator adjuster programs are ‘bleeding patients dry’
Stephanie Lapidow
For too many New Jerseyans, the cost of life-saving medications is more than just a burden, it’s an insurmountable barrier standing between them and their health. If you or a loved one has ever faced a sky-high copay or watched your savings disappear trying to afford essential medication, you know the devastating reality of our broken health care system.
The New Jersey Legislature is considering a bill (S-3818/A-5217) that would put an end to a little-known exploitative insurance practice that is crushing patients. This legislation would require that patient assistance be applied to copayments, coinsurance, deductibles and other out-of-pocket costs. In plain terms, it would ensure that the financial assistance patients receive actually benefits them, rather than padding the profits of insurance companies.
Prescription drug costs can be staggering, particularly for people managing chronic illnesses. Whether you’re living with a rare disorder, battling cancer, or relying on daily medication to survive, affordability shouldn’t be a barrier to care. I have seen this struggle up close through my work with the Hemophilia Association of New Jersey.
Hemophilia is a rare genetic disorder that prevents blood from clotting properly, making even minor injuries dangerous. Without treatment, internal bleeding can lead to severe joint damage, organ failure, or even death. Thankfully, modern medicine has developed treatments that allow people with hemophilia to live relatively normal lives. But those treatments come with a hefty price tag — anywhere from $30,000 to $100,000 a month.
Because of these astronomical costs, many patients rely on copay assistance from drug manufacturers to afford their medications. These programs can cover an individual’s entire deductible or out-of-pocket maximum, allowing them to get the treatment they need without going into financial ruin. At the same time, insurance companies still receive the full amount they are owed for the cost of care.
For years, this system, while far from perfect, at least made life-saving treatments attainable. That changed in 2023, when insurance companies began implementing copay accumulator adjuster programs which have been bleeding patients dry.
Here’s how it works: Under copay accumulator programs, the assistance patients re ceive no longer counts toward their deductible or out-of-pocket maximum. That means even if a drug manufacturer provides thousands of dollars in financial aid, patients are still on the hook for the full cost of their insurance obligations. Essentially, insurers are double-dipping — taking the copay assistance and then turning around and demanding even more money from patients.
One of our members learned this the hard way. They had no idea their insurance plan had adopted a copay accumulator program until they were suddenly hit with a $7,000 bill seven months after their plan had renewed. Despite receiving $12,000 in copay assistance, money that went directly to their insurer, they were told they still owed thousands out of pocket. The financial devastation was immediate.
This is not just an issue of policy, it’s an issue of fairness, of decency, and one with human lives literally hanging in the balance. It is unacceptable that insurers can exploit patients who are simply trying to manage their conditions.
New Jersey has an opportunity to stop this predatory practice by passing S-3818/A-5217. This legislation will ensure that when patients receive copay assistance, it actually helps them as it was intended. People living with chronic illnesses and rare disorders deserve better than to be nickel-and-dimed into medical debt. They deserve access to the life-saving treatments they need, without deceptive loopholes which strip them of financial stability.
It’s time for New Jersey to put patients first and put an end to this unjust practice. The Legislature must act now.