Terms & Definitions
Copay Assistance
Is financial assistance typically provided by charitable organizations or drug manufacturers to help patients pay out-of-pocket costs for their medications or health care services
Coinsurance
The out-of-pocket costs a patient owes for a service or medication, calculated as a percentage of the total cost
Copay Accumulator Adjustment Programs
Exclude copay assistance payments from counting toward a patient’s annual deductible or out-of-pocket maximum. These programs undermine access to life-saving prescription drugs, making it more difficult for people living with chronic illnesses to adhere to a treatment plan
Deductible
The dollar amount the insured must pay per plan year before insurance coverage begins
Out-of-Pocket (OOP) Maximum
The maximum dollar amount the insured is obligated to pay for services/treatments during the plan year, after which insurance will cover 100 percent of the costs
Policy Solution
Lawmakers can help patients afford critical treatments by ensuring all payments – made by or on behalf of patients – are counted toward the patients’ deductibles and out-of-pocket maximums
Copay Accumulator Adjustment Programs & the UACCC
Common Misconceptions:
12 states have protected patients by passing legislation to ensure all copays count:
