Feb. 28, 2020

How Insurers Double Dip with Copay Accumulators

How Insurers Double Dip with Copay Accumulators

The Centers for Medicare & Medicaid services are about to put a rule in place that allows insurers and pharmacy benefit managers to get paid TWICE for some of your prescriptions. 

This policy is called “the copay accumulator,” and it allows insurers to accept payment for a drug without applying the payment to your deductible. 

In the first episode of the Patients Rising Podcast, we discuss copay accumulators, and what patients need to know about them. We also talk about a looming deadline to comment on a proposed federal rule on the topic. 

How to take action

The deadline to comment on the rule regarding copay accumulators is 11:59 pm eastern standard time Monday, March 2nd, 2020.

Let your voice be heard. Send your comments directly to Seema Verma, Administrator, Centers for Medicaid and Medicare Services (CMS).

Tell her to honor your already high out of pocket costs, and to allow copay assistance to be applied to your deductible. 

You can also do this directly from our website

Guest:

Carl Schmid, Executive Director, HIV + Hepatitis Policy Institute, Washington, D.C.

Carl Schmid has been a national policy and advocacy leader in the HIV community for over 20 years.  He spent 16 years with The AIDS Institute, where he served as its Deputy Executive Director and led the Institute’s HIV and viral hepatitis federal policy work before the executive agencies and the Congress. In December 2019, he left The AIDS Institute to form the HIV + Hepatitis Policy Institute, which promotes quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.

Mr. Schmid helps lead the HIV and hepatitis communities’ advocacy efforts in Washington, D.C., to ensure domestic HIV and hepatitis programs, including the Ending the HIV Epidemic initiative, the Ryan White Program, CDC HIV and hepatitis prevention programs, and NIH AIDS Research, are based on sound public policy and receive full funding. 

He has expertise in healthcare financing systems, including Medicaid and Medicare, and leads efforts to ensure that the Affordable Care Act meets the needs of people living with or at risk of HIV and hepatitis. As part of HIV + Hep’s work in advocating for people with HIV and hepatitis, Mr. Schmid works extensively with other patient and disease groups on collective efforts to ensure that patients, particularly those with chronic conditions, have access to quality and affordable healthcare, including prescription medications.

Mr. Schmid served as a consumer representative to the National Association of Insurance Commissioners in 2018-19.  In July 2019, he was appointed to the PEPFAR Scientific Advisory Board.

He was a member of the Presidential Advisory Council on HIV/AIDS from 2007-09 and chaired its Domestic Subcommittee.  In 2010, he was named by POZ magazine as one of the 100 most effective AIDS fighters and by Whitman-Walker Health as one of the 25 individuals who have played prominent roles in the fight against HIV in D.C. In 2016, he was named the Champion of the Year by the ADAP Advocacy Association. 

Mr. Schmid earned a B.A. in Public Affairs and a M.B.A. in International Affairs from the George Washington University in Washington, D.C.

Hosts:

Terry Wilcox, Executive Director, Patients Rising

Dr. Robert Goldberg, “Dr. Bob”, Co-Founder and Vice President of the Center for Medicine in the Public Interest.

Kate Pecora, Field Correspondent