The Lupus Foundation of America is dedicated to improving the lives of people with lupus. One of the many ways the Foundation accomplishes this is through advocating for state and federal policy that will help with access to quality healthcare and medication.
We know through our work with the lupus community that there are many barriers to accessing quality, comprehensive, affordable healthcare. In the last few years, insurance companies have implemented polices, called copay accumulators, that can further limit access to care and increase costs for people with lupus.
Living with lupus can be expensive as research has shown it can cost over $68,000 annually depending on the severity of the disease. Assistance programs are available to help people with lupus afford the costs of their care, including the cost of medications. These assistance programs can be offered by non-profit organizations, state government agencies, or pharmaceutical companies. While patient assistance programs can take many forms, under prescription drug assistance programs, a portion of a person’s drug cost is paid by a third-party entity – that is, not the person themselves and not the insurance company.
Simply put, a copay accumulator is a policy in which third-party assistance is not counted towards a patient’s annual cost-sharing requirements, including their deductible and out-of-pocket maximums. Often times, people are not aware that their insurance includes a copay accumulator until it impacts them at the pharmacy counter.
The Foundation is actively working to enact legislation at both the state and federal level (HELP Copays Act) to ensure that copay assistance received by a patient counts towards their cost-sharing requirements.