Stephanie arrives at the pharmacy to pick up her medication – while she is no longer able to use the coupon card because she has already used it five times, she knows the the coupon covered $3,750 of her costs, and she will only owe the remaining $250 to satisfy her $4,000 deductible and an additional small copay. The pharmacist rings her up and tells her that she owes $750.
At the pharmacy counter, Stephanie learns that because her insurance plan has a copay accumulator, her coupon card payments did not count towards her deductible. That means she needs to continue to pay $750 out of pocket over the coming months until her $4,000 deductible is met. Because of the copay accumulator, the insurance company will collect $7,750 on behalf of Stephanie – $4,000 out of her pocket, and $3,750 via the assistance program.
Stephanie, having planned and budgeted to make the $250 payment she was expecting, now cannot afford her medication. She leaves the pharmacy unable to fill her prescription and will begin missing doses that could jeopardize her health.
This is the story for many patients. They are unaware their insurance plan has a copay accumulator policy in place until they have used up their copay coupon card and have realized their deductible has not been lowered. This is especially harmful for people with lupus who are on several medications at the same time, and a delay or not taking a medication at all could be detrimental to their health.