Activists warn of hidden provision in insurance plans for HIV drugs


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Carl Schmid, the AIDS Institute’s deputy executive director, said the co-pay accumulator adjustment is surfacing more in plans offered by health insurance companies. (Washington Blade file photo by Michael Key)

Officials with organizations representing people with HIV and other chronic illnesses are urging patients who rely on drug manufacturers’ co-pay assistance contributions to help lower the cost of their prescription medication to be extra careful if they decide to select a new health insurance plan.

In a press conference on Wednesday, officials with the AIDS Institute, the Arthritis Foundation, and the National Organization for Rare Disorders warned that a growing number of insurers are refusing to allow co-payment assistance coupons provided by drug manufacturers from counting toward patients’ annual deductibles.

The officials noted that insurers have quietly added in fine print to insurance policy contracts a practice they call a “copay accumulator adjustment” that can cost the patient thousands of dollars more each year in out-of-pocket costs for their often life-saving drugs.

Carl Schmid, the AIDS Institute’s deputy executive director, said the co-pay accumulator adjustment is surfacing “more and more” in plans offered by health insurance companies. He said many of the companies are associated with state and D.C. insurance exchanges operated under the Affordable Care Act, which is better known as Obamacare.

He said the practice is also being adopted by insurers retained by private employers that provide employee health insurance benefits.

In May of this year, the AIDS Institute was part of a coalition of 60 HIV organizations from throughout the country that called on insurance commissioners and attorneys general in all 50 states and D.C. to investigate the co-pay accumulator adjustment practice as a possible violation of consumer protection laws.

Among other things, the coalition members pointed out insurers were not making it clear to consumers that the “accumulator” policy was being added to their insurance plan because it was “buried” in hard-to-understand language.

Schmid and fellow coalition partners pointed out in their May letter that co-pay assistance from drug manufacturers through payment coupons or payment cards enables HIV patients and HIV-negative people on the HIV prevention drug regimen known as PrEP to save thousands of dollars a year on their share of the costs of the drugs through their insurance plans. They noted that the sudden decision earlier this year by many insurers to no longer allow co-pay assistance to go toward the insurance deductible could force those on PrEP to pay $4,000 or more a year for the PrEP drug Truvada.

Such a steep increase would likely prompt some to discontinue participation in the PrEP regimen, which could increase their chances of contracting HIV, the coalition members said.

An official with the D.C. Department of Insurance, Securities, and Banking has said the department was looking into the concerns raised by the coalition. But a spokesperson for the department told the Washington Blade last week that the department had not received any complaints from consumers about the “accumulator” practice and there were no immediate plans to take any action on the practice.

“The issue now is we just want people to be aware of this,” said Schmid. “That is the purpose of the press conference,” he said, adding that his and the other two organizations participating in the Wednesday press conference want patients to carefully study the fine print and provisions of any new insurance plan they consider signing on to.

The Obamacare open enrollment period for seeking a new insurance plans begins on Oct. 15.

“You look at the premiums,” said Schmid in noting the criteria for selecting a plan. “You look at the formularies to see if your drugs are on it. You look at the co-pays and the co-insurance and the deductible,” he said. “And now this is something else you have to look at,” he said, pointing to the copay accumulator adjustment.



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