Advocates support House Bill 4987 to Address rising costs from AAP

Patient Advocacy Groups are calling on South Carolina Legislators to support bipartisan legislation to address rising out-of-pocket costs from an emerging insurance practice called “Accumulator Adjustment Programs (AAP).”

This legislation will help patients better access their medicine and stay adherent.

Unfortunately, health insurers and PBMs have adopted polices, often referred to as “accumulator adjustment programs” that block assistance towards a patient’s deductible and maximum out-of- pocket limits.

AAPs further shift cost to patients, putting patients at risk of not being able to afford their medicines.

South Carolinians need health insurers to count ALL payments and not discriminate against those patients living with chronic conditions.

13 states, plus Puerto Rico, have laws prohibiting accumulator policies – AR, AZ, CT, GA, KY, IL, LA, NC, OK, TN, VA, WA, WV

PROBLEM: When it comes to medication coverage, health plans continue to shift the cost burden to patients through:
  • High Deductibles or
  • Co-insurance

COPAY ASSISTANCE: Drug manufacturers, health foundations, charities, and nonprofit organizations help patients with assistance programs that cover addional cost patients are required to pay. These programs are critical for patients with chronic, complex conditions

H.4987 ADDRESSES: This legislation directs insurers to count all cost-sharing payments made by the patient or on the patient’s behalf toward their deductible and out-of- pocket maximum.