S4, Ep 4- Healthcare Deception: Exposing Copay Accumulator and Maximizer Schemes

In this episode of "Healthcare Matters," join hosts Dr. Robert Popovian and Conner Mertens as they unravel the shady practice known as “copay accumulator adjustors.” Joined by JP Summers, a patient advocate and chronic disease patient herself, they’ll shed light on this practice employed by pharmacy benefit management companies and insurers. You’ll learn how these policies adversely affect patients by preventing patient assistance from applying towards deductibles, leading to financial and emotional burdens. The hosts debunk myths about rising premiums when legislation prohibiting maximizer and accumulator practices is passed, using credible research and data to create an online free interactive tool. Tune in for insightful discussions and personal stories that underscore the urgency of reforming copay accumulator policies.

Among the highlights in this episode:

02:16: Dr. Popovian lays out what a ‘copay accumulator adjustor’ is, and how pharmacy benefit managers and insurers can keep patients from reaching their deductibles using these shady practices. He also explains how they impact patients' out-of-pocket costs.

03:38: Conner provides an anecdote about how these policies look in practice, and how they can impact a patient’s deductible.

04:44: JP shares her personal experience as a patient affected by copay accumulator policies and how it impacted her ability to afford necessary medications. She continues on to show how these practices also negatively impacted her health, her family’s health, and their lives overall. “Never in my life, did I think I would have to choose a loved-one’s health over mine.”

07:11: JP describes the different advocacy efforts she’s undertaken to raise awareness about copay accumulator policies and the impact of her storytelling on creating change. Sharing our stories can be difficult, but ultimately rewarding when it can be used to influence policies that make patient’s lives easier.

08:46: Conner begins exploring the myth that copay accumulator bans will lead to rising insurance premiums. He introduces the GHLF research and data that directly refute those claims. Dr. Popovian explains what the data all means: “What we found…is that there was no statistical differences between states that had passed the bans, and states that hadn’t passed the bans.” He goes on to emphasize that on the state and federal level, there is strong bipartisan support for these bans.

11:15: We hear from Anne Sydor (GHLF Director of Research, Development, and Communications) about where the data was collected from and the transparent methods of analysis for the research presented within the free GHLF tool. She also outlines how patients can know if they are being impacted by a copay accumulator adjustor program.

13:29: Esteban Rivera (GHLF Data Scientist) further explains what the data shows: “…There’s no significant statistical relationship between the passing of legislation, on an increase in premium pricing.”

14:52: Conner shares his closing thoughts on the myth of rising premium costs as a result to passing copay accumulator bans. 

15:31: Dr. Popovian gets the last word on the importance of protecting patients from predatory practices.

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: [e-mail]

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: [e-mail]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [e-mail]

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.