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Committee advances bill to ban co-pay accumulator adjusters after patient and insurer testimony
Summary
S3818/A5217, which would require co-pay assistance to count toward patients' deductibles and out-of-pocket maxima, was favorably released by the Senate Budget and Appropriations Committee after testimony from patient groups, cancer advocates and health plan representatives.
The Senate Budget and Appropriations Committee on June 9 voted to release S3818/A5217, legislation that would prohibit health insurers from refusing to count third‑party co-pay assistance toward a patient's deductible or out-of-pocket maximum.
Patient advocates, clinicians and disease-specific groups told the committee co-pay accumulator adjuster programs have led to surprise bills and treatment delays. Stephanie Lapidau, executive director of the Hemophilia Association of New Jersey, described an example in which a member received a bill for more than $7,000 after their manufacturer's assistance was exhausted and the insurer reset cost-sharing to zero. "A co pay accumulator adjuster program is when a patient's out of pocket maximum and deductible are not reduced based on their co pay assistance used," she said.
American Cancer Society Cancer Action Network volunteers and survivors also urged passage. "This bill is not about raising costs, it's about ensuring that cost assistance works as intended," Dr. Stephanie Chapellican, an ACS CAN volunteer and cancer survivor, said in testimony.
Representatives of insurers and plan sponsors warned of higher system costs and raised federal preemption questions for self-funded ERISA plans. Ward Sanders of the New Jersey Association of Health Plans said accumulators are a plan-design option offered to employers and that the bill would increase costs for some plan sponsors. He also pointed to a fiscal note indicating a potential cost impact to the State Health Benefits Program, and flagged legal questions about application to self‑funded plans.
Why it matters: advocates said accumulators undercut manufacturer and charitable assistance programs that patients rely on for high-cost medications such as clotting factors and some cancer therapies; insurers said the practice responds to manufacturer couponing that can raise plan costs.
The committee released S3818 and A5217 with committee amendments. Members asked for follow-up information on the amendments’ exemptions and on the fiscal impact to the State Health Benefits Program; a committee member noted the amendments appeared to exempt the state plan. The vote sends the bills to the next legislative stage; it does not enact law.
Discussion vs. decision: the committee’s action was to release the bills with amendments. Witnesses requested changes and analyses; insurers requested additional consumer protections if the bill advances.
