At UnitedHealthcare, we are committed to improving the health care system. UnitedHealthcare is an operating division of UnitedHealth Group, the largest single health carrier in. This program requires providers to submit payment information received from drug manufacturer copay coupon pr ograms which are applied to a member s cost share when billing for specialty medications as a medical benefit drug claim. Created Date: 9/18/2020 12:48:51 PM.
The following post is from Julie Baak, the Practice Manager for the Arthritis Center in Saint Louis, Missouri and a fierce patient advocate.
What is a Copay Accumulator?
Copay accumulator programs target the most costly specialty drugs. These drugs often have copay assistance programs in place to help offset costs to patients. A copay assistance program is where a drug company arranges for financial assistance to credit the patient’s account directly at the pharmacy counter. The goal of assistance is to help lessen the deductible burden and rising out of pocket costs for patients.
Beginning in 2018, insurers like United Healthcare (UHC) and Blue Cross Blue Shield, started crediting this assistance to the insurance company, often leaving patients stranded at the pharmacy counter unable to pick up their medication once their assistance award ran out.
Beyond the Pharmacy Counter
Now they want to take it beyond the pharmacy counter and into the doctor’s office. Beginning on January 1, 2021, UHC will take their copay accumulator policy a step further and also pocket the assistance of patients who receive infusions in their doctor’s office. This policy will affect many of those who receive infusion therapy, like patients with cancer, arthritis, AIDS, and multiple sclerosis.
UHC’s new Copay Accumulator Policy could financially ruin many of the most vulnerable patients. To be clear, this policy allows the insurance company to double dip and get paid twice. Once from the drug manufacturers copay assistance program and then again from our chronic disease patients. The best part is the new name: the Accumulator Adjustment Medical Benefit Program.
The operative word here is Benefit. A big benefit for UHC, and a slap in the face for many chronic disease patients like the ones we treat here at our offices in St. Louis.
What Will Happen?
Patients who are already dealing with chronic diseases often rely on manufacturers assistance programs to pay for their medicines. Without these programs, they simply will not be able to stay on therapy. With UHC’s new Accumulator Policy it will prohibit all assistance programs from counting towards the patient deductible and out of pocket expenses.
Simply put, many of our patients — and patients around the country — will not be able to stay on their therapy.
Crushing Patients Amid Record Profits
UHC has reported record profits for 2020, with their pharmacy business driving their growth. But they want more, and sadly they have made an internal decision that the best place to get it is off the backs of chronic disease patients. As you gear up for open enrollment, look closely at your plan and find out how this may affect you.
State Bans
Several states have banned the use of copay accumulators with legislation, but often this does not help self-funded employer plans. Even if you live in a state with a copay accumulator ban — if your employer has implemented this practice — this ban does not help you. States that have enacted bans include: Arizona, Georgia, Illinois, Virginia, and West Virginia. You can follow states with active legislation via this map on our friends at Aimed Alliance’s website. Sadly, the state where our practice resides, Missouri, has not banned copay accumulators and we do not have any active legislation.
Threatens Health Outcomes for Patients
This policy threatens the health outcomes for millions of patients in the middle of a pandemic. Physicians are already burdened with excess paperwork. This increases that load and harms patients. And to top it off, UHC expects the physician’s office to deliver this new policy message to the patient, and then bill them for the difference. Click here to read the new policy.
Our office has reached out to the UHC provider representatives and the response has been the usual run around. Here is the drill:
- Call the phone number in the policy announcement letter;
- Get transferred around UHC; and finally
- Get told to email our representative — the one who originally told us to call the phone number in the letter.
We Opt Out
Our medical director will not be a part of this policy. After 27 years as a UHC rheumatology provider, we have made the decision not to do business with them. We informed UHC that we will be mailing letters to our patients on November 2nd with this message and have yet to receive a response.
An October Surprise?
It is hard to know if this is one of those UHC ‘October Surprise’ policies. They have a rich history of trying out devastating policies and then retracting them once patients and physicians complain. Our office has been stretched to the limit during COVID-19, so we must take all of these policies seriously and make internal changes accordingly. It would be great if one day they would consider their customers — patients — before making these policies.
There is a lot of talk about coverage for preexisting conditions. Both parties want that coverage. As someone who works with patients every day, I speak from experience when I tell you that implementing policies like these is discrimination against patients with preexisting conditions. Yes, they are covered, but they are no longer being cared for by this company.
What Can You Do?
Physician offices can let their voices be heard on social media, twitter, email and letters to UHC, legislators and advocacy organizations. several advocacy organizations have already sent a letter to UHC signed by 12 groups on 10/7/2020 but no UHC response has been forthcoming. Here is a link to that letter: Letter to United Health
Patients, please call your employers and educate them on what this UHC policy actually means to you and reach out to advocacy organizations such as Patients Rising by emailing: AskUsAnything@patientsrising.org or calling them at 800-685-2654. If you have been affected by a copay accumulator of any kind, please share your story at Patients Rising Stories.
It is a sad state of affairs that the health insurance that is supposed to protect our patients, is actively working against them.
United Health Care (AARP) announced today they were waiving the cost share on Medicare Advantage plans. The following is the announcement:
Member’s health is our priority. Recently, we shared news that UnitedHealth Group is taking additional action to directly support people affected by the COVID-19 pandemic by providing over $1.5 billion of additional support for our customers. We wanted to share more details with you.
To help member’s get the care they need, we are waiving cost-share (copays, coinsurance and deductibles) for our Medicare Advantage plan members as follows. Members will have a $0 copay for primary care provider (PCP) and specialist physician services, as well as other covered services (listed below) between May 11, 2020 until at least September 30, 2020. By lowering our PCP and specialist copays to $0, along with our telehealth cost-share waiver, we hope to help make it easier for member’s to access care.
Services included
The following services, if covered by a member’s plan, are eligible for a $0 copay under the cost share waiver, but do not include diagnostic tests and certain other services.
- Primary care provider (PCP) office visits
- Specialist physician office visits
- Physician assistant or nurse practitioner office visits
- Medicare-covered chiropractic and acupuncture services
- Podiatry services and routine eye and hearing exams
- Physical therapy, occupational therapy and speech therapy
- Cardiac and pulmonary rehabilitation services
- Outpatient mental health and substance abuse visits
- Opioid treatment services
The $0 copay applies to services from a network provider and out-of-network services covered by the plan.
Member cost share is not waived for the following services, unless they are related to COVID-19 testing or treatments:
- Lab and Diagnostic tests (radiological and non-radiological)
- Part B and Part D drugs
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies
- Renal Dialysis
- Other services not covered by your plan
Copays, Coinsurance and deductibles for services in the following settings are not waived. Members will be responsible for their share of the cost under their benefit:
- Inpatient hospital and Outpatient surgery or observation services
- Skilled Nursing Facilities
- Emergency, Urgent and Ambulance services
United Healthcare Mental Health Copay
Eligible Members
The cost-share waiver applies to all UnitedHealthcare Medicare Advantage members, including members of Special Needs Plans (SNP) and UnitedHealthcare Group Medicare Advantage plans.
Unitedhealthcare Copay Plan
This information is posted on our UnitedHealthcare COVID-19 Health and Wellness page for members. Thank you for being a partner in care to our members during this time.