Copay Accumulators and Maximizers

To increase access and affordability of infusion medications, many manufacturers offer copay assistance to infusion patients. In response, insurers have implemented copay accumulator and maximizer programs that prevent copay assistance from counting toward a patient’s deductible or out-of-pocket maximum, leading to surprise bills and missed treatments.

A copay accumulator program is a policy implemented by an insurance company that allows an insurer to collect a patient’s copay assistance but does not count the assistance toward the patient’s deductible or out-of-pocket maximum.

A copay maximizer program is a similar policy, but the maximum value of the copay assistance is evenly applied throughout the patient’s plan year, preventing the patient from reaching their deductible or out-of-pocket maximum.

The “all copays count” legislative movement has curtailed or prohibited both of these programs by requiring that insurers count any amount paid by a patient or on behalf of the patient to count toward their out-of-pocket responsibility.