Patients in South Carolina often rely on copay assistance to afford their medications. However, health insurers and pharmacy benefit managers (PBMs) are using the assistance to reduce their own costs while placing an extreme financial burden on patients, often forcing them to forgo the treatment they need.
South Carolina must ensure that patient assistance goes to patients, not insurers. Stop our insurance companies from double-dipping and receiving two deductibles.
Copay Assistance is provided by drug manufacturers, charitable foundations and other third parties to help patients pay for their prescriptions, enabling them to afford medications that they would otherwise wouldn’t have access to.
Copay Accumulators are programs through which health plans and pharmacy benefit managers (PBMs) prevent copay assistance given to patients from counting towards their deductible and maximum out-of-pocket spending. As a result, insurers receive more than their fair share for each prescription, first from patients’ copay cards and again from patients’ out-of-pocket funds once the copay card is maximized and their deductible is deemed to have not been met.