The Hidden Costs of Discount Cards
By Emma Ryan
New policies for coupons to purchase prescription drugs mean some people may pay more out of pocket
For many people with diabetes who rely on prescription drugs, copay cards or discount coupons make essential medications affordable. And, these discount cards have a double benefit. In addition to discounting the price, the original price would be counted towards your deductible, which is the amount paid out of pocket before insurance starts to pick up costs, rather than the discounted amount you actually paid for. This helped people reach their deductible even if they had not actually paid the entire amount themselves.
This benefit is going away. Indeed, many people have noticed a change: many insurers are no longer counting these coupons toward your deductible. The amount that people pay outside the coupons will still count toward the deductible, but the rest of the drug cost usually paid by the manufacturer will not be. In other words, as Patty Telgener from Emerson Consultants succinctly said, “it is changing the policy so only the actual out of pocket expense paid by the patient would count toward the deductible.” These new policies are called “accumulator adjustment programs.” What this means is that some people may ultimately pay more for some of their supplies.
Unfortunately, patients who have benefited from these coupons in the past may not be aware of the change. As we understand it, some insurers have introduced accumulator adjustment programs without notification. In the meantime, to avoid any unpleasant surprises of paying more out of pocket this year, check if your insurance plan includes an accumulator program.
United Healthcare calls this “Coupon Adjustment: Benefit Plan Protection”
Express Scripts calls it “Out of Pocket Protection.”
For background on copay cards and other insurance terms, click here.
What is an accumulator adjustment?
When purchasing medication using a discount coupon, the amount covered by the coupon typically counts toward a yearly deductible (the amount you pay before your insurance plan “kicks in”). However, a new policy adopted by many insurance plans, employers, and pharmacy benefit managers (the “middlemen” between drug manufacturers and insurance companies) stops these coupons from contributing to deductibles.
In other words, say your deductible is $100. The cost of the drug is $100, but a copay card brings down the price to $5 and that is the amount you pay out of pocket. Under traditional policy, it’s the cost of the drug – $100 – that is counted towards your deductible, so in this scenario you’ve met your $100 deductible even after paying only $5 of your own money. Under accumulator adjustment, this changes so that you’ve only paid $5 out of your $100 deductible, so you will have to pay $95 more before insurance picks up the cost.
To be sure, discount cards still lower prices, but accumulator adjustment programs effectively force people to pay more to reach their deductible.
Insurers defend the change
Insurers say that these programs discourage people from overusing high-priced drugs. When discount coupons keep out-of-pocket costs low for patients, insurers argue that there is no incentive for healthcare providers to prescribe a more cost-effective drug or for drug manufacturers to reduce the price of their medications.
For now, co-pay coupons can still help reduce the financial burden on patients, even as insurers require beneficiaries to cover a greater percentage of those costs. As always, we hope that patients can work with their healthcare providers to make sure they receive the optimal therapies and that they can afford them or find a good substitute.