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Accumulator Adjuster Programs: What You Need to Know

Accumulator Adjuster Programs (AAPs) are programs Pharmacy Benefit Managers (PBMs) provide, mostly to large self-insured employers, which is applied to patients who use drug co-pay cards and other forms of manufacturer co-pay assistance. Under an AAP, a PBM accepts co-pay assistance for out-of-pocket costs associated with a prescribed drug聽but then doesn鈥檛 credit that amount toward the patient鈥檚 overall deductible. This means that the PBM will draw down the full value of the co-pay card and still require the patient to pay co-pays (for additional medication fills, doctor鈥檚 visits, etc.) up to the yearly out-of-pocket maximum. The manufacturer assistance will not apply toward satisfying the yearly maximum.

HFA is working to educate health plans and PBMs about the dangers posed by AAPs.聽If you have received a letter from your employer or benefits manager stating that your co-pay cards will no longer be applied to your deductible, HFA needs to hear from you.聽Please聽share your story with聽Project CALLS. Collecting data about these issues is the only way to fight their implementation!

Read More About AAPs from Dear Addy


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