Show-Me State Times

A Missouri spokesperson for the American Cancer Society Cancer Action Network (ACS CAN) said the state legislature “missed an opportunity” to help her members by not passing legislation to ban “Copay Accumulator Adjustment Programs” (CAAPS).

“Cancer survivors were disappointed that the legislature missed an opportunity to help them with their out-of-pocket costs,” said ACS CAN Missouri government relationships director Emily Kalmer in a statement. “They traveled from across the state to advocate for a bill that would require more health insurance plans to count all prescription drug copayments made by or on behalf of Missourians.” 

“This important health policy reform would prevent an increasingly common practice used by insurance companies and pharmacy benefit managers called ‘copay accumulator adjuster programs’ that prevent prescription drug copay assistance from counting towards a patient’s deductible or out-of-pocket maximum,” said Kalmer.

A copay accumulator is a program used by some health insurers in the United States that does not count copay assistance payments toward a patient's deductible or out-of-pocket maximum.

Missouri is one of thirty states that allows copay accumulators, reported Show-Me State Times on Monday.

The Missouri state legislature considered two bills, SB 844 and HB 1628, in the just-ended legislative session. These bills would have required health insurers to put all copay assistance payments toward patient deductibles and out-of-pocket maximums in the state. 

The legislation was not enacted.

“If this legislation is not passed and copays aren’t counted towards a patient’s deductible the patient will have to basically pay twice, first with their copays assistance card, second from the patient,” Bridget Tyrey, executive director of the Gateway Hemophilia Association (GHA), told St. Louis Reporter in March.

“Patients already have extra medical costs, have gone through pre authorization, step therapy, this is another barrier to receiving their life saving medication,” said Tyrey, whose son has hemophilia.

While some health insurers say banning CAAPS would result in higher insurance premiums, a May 2023 analysis by The AIDS Institute found "no evidence that enacting a copay accumulator adjustment ban has a meaningful impact on average premiums." That analysis looked at 16 states that banned CAAPS between 2019 and 2022.

A recent study conducted by the National Hemophilia Foundation found that 69% of patients who depend on financial assistance to afford their medications make less than $40,000 a year.