A state-level comparison suggests concerns about copay accumulator bans may be misguided.
WASHINGTON, DC, UNITED STATES, November 9, 2026 /EINPresswire.com/ -- Drug manufacturers often offer copay assistance to help patients cover their share of a prescription drug's cost. In commercial plans with copay accumulator programs, that assistance doesn’t count toward the patient’s deductible. Patients in copay accumulator programs may face unexpected costs that make them less likely to take their medicines as prescribed.
Federal regulations prohibiting accumulators in most situations have generally not been enforced due to concerns that premiums will rise. A majority of states have intervened by banning copay accumulators while others have not, allowing researchers to compare premium trends across the two groups. New research published in Health Affairs Scholar finds the evidence does not support premium increase concerns for states with bans.
“The Effect of State Copay Accumulator Bans on Premiums in Commercial Health Insurance Markets,” comes at a critical moment as additional states consider copay accumulator bans and policymakers assess their potential impact on insurance premiums.
“At a time when Americans are struggling with affording prescription drugs, pharmacy benefit managers (PBMs) and insurers should not be permitted to divert manufacturer copay assistance away from patients,” said Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “The impact these policies have on patients deserves attention; HHS and more states can play a role by requiring that manufacturer copay assistance count toward patients’ cost-sharing obligations.”
The study was authored by Yevgeniy Feyman, PhD, Kimberly Westrich, MA, William Sarraille, JD, Rory Martin, PhD, David Choi, PharmD, and Jonathan D. Campbell, PhD. It compares premium changes in states with and without bans, using a staggered difference-in-differences design to account for states adopting bans at different times, and to control for state Medicaid expansion.
What the evidence says:
• Before statistical adjustment, premiums grew 20.8% from 2020 to 2024 in states that enacted bans through 2023, compared with 24.2% in states that did not.
• In 13 states that banned accumulators through 2023, the bans had no statistically significant effect on average annual premiums in fully insured small- and large-group plans from 2020 to 2024.
• Across all scenario analyses, the estimated effect was small (under 1% of annual premiums) and not statistically significant.
“Policymakers need reliable evidence to understand the broader effects of copay accumulator policies, particularly when evaluating concerns about what’s driving the rise of premiums,” said Dr. Campbell, Chief Science Officer at the National Pharmaceutical Council. “This study adds to the evidence decision-makers should weigh as they consider the impacts these policies have on patients and healthcare systems.”
The authors drew on insurers’ Medical Loss Ratio filings with the federal government. From 2014 to 2024, the filings covered an average of 63.2 million people a year. The findings note that insurers may have responded to bans in other ways, such as changes to prior authorization, cost sharing, or formulary coverage, which the authors say requires further research. They conclude that more states could adopt bans without likely raising costs for enrollees or employers, and that HHS enforcement of the federal standard could be considered.
About the National Pharmaceutical Council
NPC serves patients and society with policy-relevant research on the value of patient access to innovative medicines and the importance of scientific advancement. We envision a world where advances in medicine are accessible to patients, valued by society, and sustainably reimbursed by payers to ensure continued innovation. For more information, visit www.npcnow.org and follow NPC on LinkedIn.
Rebekah Pepper
National Pharmaceutical Council (NPC)
+1 202-827-2078
media@npcnow.org
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