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Employer-sponsored health insurance covers nearly 155 million people in the United States. Providing comprehensive health plan benefits and coverage is an important tool for employers to show how they value their employees. However, for employers this can be a costly means of compensation. On average, coverage for a single individual costs an employer nearly $6,000 per year, while family coverage costs an estimated $15,000. Therefore, employers are understandably looking for means to reduce their health care costs.
A recent approach adopted by health plans to lower their costs is through adopting complex benefit utilization policies, such as copay accumulator programs. When individuals with chronic conditions cannot afford their cost-sharing requirements, they may rely on third-party assistance programs to meet their cost-sharing requirements. Typically, this third-party assistance should be counting towards the employee’s deductible and annual out-of-pocket limit. However, when an employer adopts a copay accumulator program, the plan accepts the third-party assistance but does not count this assistance towards meeting the employee’s deductible or annual out-of-pocket limit.
At first glance, these programs may seem enticing to employers; however, for employees with chronic conditions, they can be highly impactful. Employees’ copay assistance could be exhausted before they meet their deductible and annual out-of-pocket limit. This can cause employees to have to stop or limit their medication because they are unable to afford it. This type of treatment non-adherence can also result in hospitalizations and relapses in symptoms, ultimately costing the employer health plan substantially more money to get the employee healthy once again.
State and federal legislatures have begun to recognize how overly burdensome benefit utilization policies and copay accumulator programs harm individuals with chronic conditions and have begun to pass legislation to prohibit the use of such programs. Thus, it is important for employers to understand these new legal and regulatory changes as well as their short and long-term impacts on employees with chronic conditions.
Aimed Alliance and the Alliance for Patient Access (AfPA) are offering a free webinar on October 20, 2022 from 2:00PM-3:00PM ET on recent developments in benefit utilization programs, such as copay accumulator programs; how these programs can affect employees; and recommendations for employers who are considering implementing these type of “cost-saving” measures. This webinar will feature:
- A patient advocacy organization discussing the impact of benefit utilization policies and copay accumulators on patients and providers; and
- An explanation of the regulatory and legislative landscape of benefit utilization and copay accumulator programs; and
- A patient's perspective on experiences with chronic illness and the impact utilization policies can have on one's physical and mental health; and
- A strategic look at how a company benefits when its approach to health care policies are working for the employees; and
- A benefits advisor’s recommendation on how employers can implement cost-saving measures that do not harm employees with chronic conditions.
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