Understanding Health Insurance Accumulators and Maximizers
For patients with autoimmune diseases and other serious and chronic conditions, affordable access to prescribed treatments can be extremely challenging, especially when health insurance plans impose significant cost-sharing obligations, such as high copayments and coinsurance. To help pay those significant out-of-pocket costs, drug manufacturers often offer coupons, discounts, or other financial assistance.
However, many health insurance plans exclude manufacturer assistance provided to patients from counting toward patients’ annual out-of-pocket limits, forcing patients to pay more than the maximum amounts of annual cost-sharing that they are supposed to pay. Two examples of these types of practices are often referred to as “accumulator” programs and “maximizer” programs.