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New Legislation Addressing Accumulator Adjustment Programs on the Rise

posted: February 27, 2019

Accumulator Adjustment Programs, also known as “out-of-pocket protection” or “coupon adjustment” programs, are a new utilization management tool being used by insurers and pharmacy benefit managers. These alternative cost-sharing structures prevent the value of co-pay assistance from being applied towards a patient’s deductible as an out-of-pocket expense. In the past, once the value of a patient’s co-pay assistance was depleted, a patients’ deductible had been met, ensuring they could afford otherwise financially inaccessible drugs.

Several bills have been introduced in states across the country that address the unfair practices of PBMs. In just the first weeks of 2019 sessions, nine states have filed legislation seeking to regulate accumulator programs: Arizona, Connecticut, Indiana, Kentucky, Massachusetts, Oregon, Rhode Island, Virginia, and West Virginia. Others states expected to file legislation this year are Illinois and Ohio.

The OAR will continue to monitor the progress of the accumulator adjustment program bills and update membership.