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Author Topic: Attempts to eliminate copay card credit toward deductible  (Read 1727 times)

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Offline PozLawyer

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  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
    • PozLawyer Blog | Optimistic Despite It All
Attempts to eliminate copay card credit toward deductible
« on: November 03, 2017, 02:01:43 am »
Reminder to read your plan language during open enrollment, especially if you rely on copay assistance cards to meet your deductible.

A follower on twitter pointed me to a new program at United Health Plans to ignore copay assistance cards when calculating whether the member's deductible has been met.  This is from the website for brokers and agents selling UHP plans:

"The Coupon Adjustment: Benefit Plan Protection program is designed to provide a real-time solution that only includes the amount a member has paid (i.e., does not include amounts that are paid by the pharmaceutical manufacturer’s copay card program) towards a member’s deductible and out-of-pocket maximum when filled at BriovaRx, the OptumRx specialty pharmacy BriovaRx specialty pharmacy, UnitedHealthcare’s primary designated specialty pharmacy."

The stated reasoning: "Currently, copay card dollars count towards the member’s deductible and out-of-pocket (OOP) maximum, which doesn’t accurately reflect what the member is paying."

This is the only example I have seen in writing, although I have heard anecdotally of other health plans enacting similar programs.

Link to UHP program:
PozLawyer Blog at https://pozlawyer.com or http://optimisticdespiteitall.com (same site)
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.
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Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
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Offline tinner65841

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  • Posts: 1
Re: Attempts to eliminate copay card credit toward deductible
« Reply #1 on: January 11, 2018, 12:23:42 pm »
 Looks like they got this done in 2018 with united health care.


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