American Society of Plastic Surgeons
For Consumers

ASPS Joins the Fight to Preserve Copay Assistance

The practice of insurance companies attempting to limit patients' use of copay assistance is a troubling trend designed to minimize the cost to insurers of providing patients with the medication they need. ASPS has joined the fight to prevent this practice and protect both patients and providers.


Copay assistance programs can offer significant out-of-pocket savings on costly medications. The program acts as a coupon that reduces the cost of prescription drugs by drastically decreasing a patient's copay. The difference is covered by the pharmaceutical company producing the medication.

Copay assistance programs have recently been met with opposition from health insurance providers in various states. Private insurers oppose the programs because they are left to cover the remainder of the difference in the patient's bill after the pharmaceutical manufacturer covers the copay. When costly medications are being discounted, insurers may be paying thousands of dollars each month for a given patient.

However, the primary reason insurers are opposed to copay assistance programs, and even support banning them in some cases, is based on instances where an individual utilizes the program when a less expensive, generic alternative is available. Simply put, in this scenario the patient could pay the same price for a name-brand drug as a generic drug, but the insurer is left paying significantly more for that patient's name-brand medication.

But for patients, copay assistance can serve as a critical lifeline when no generic alternative is available for the medication he or she needs. The program can mean the difference between affording and taking a drug as directed and not. For some patients, it is the difference between life and death.

ASPS joins the fight

ASPS believes the practice of limiting patients' use of copay assistance is an unacceptable abuse, and recently signed on to an Alliance of Specialty Medicine letter to UnitedHealthcare. In the letter, ASPS and its Alliance partners called on the insurance giant to halt the implementation of its "copay accumulator" policy, which would prevent copay assistance funds from being applied towards patients' deductibles and out-of-pocket maximums. In addition, the policy would require physicians to report to the carrier whether a patient is using copay assistance for a medical benefit drug.

The AMA House of Delegates also approved a resolution calling on the AMA to actively seek legislative bans on this practice at the state level.

These combined efforts proved successful. Only one week after the Alliance of Specialty Medicine delivered its letter of opposition, UnitedHealthcare announced that it would delay implementation of the Accumulator Adjustment-Medical Benefit program, and it will no longer take effect on January 1, 2021, as planned.

Watch for updates on this important issue as ASPS continues to fight for patients' access to the medications they need to achieve positive health outcomes.