Accumulator Adjustment Programs (AAPs)

What are they?

What are they? Accumulator Adjustment Programs (AAPs) are tools utilized by insurers and pharmacy benefit managers (PBMs) to exclude co-pay assistance as an out-of-pocket expense. This, in turn, excludes co-pay assistance from being applied to a patient’s deductible.

What this means for patients:

For patients with complex, chronic conditions, co-pay assistance is vital. Typically, it offers these patients access to their necessary medical therapies at a reasonable rate, however when it is excluded as an out-of-pocket expense, cost of care skyrockets. Patients are then left to choose between two options: endure outrageously high medical costs, or discontinue their successful treatment, leading to adverse health effects.

FSR Policy:

Nothing is more important to our organization than a patient’s health. That is why co-pay assistance should count towards the deductibles of patients with chronic conditions. We also emphasize that insurers have a responsibility to notify patients of any existing AAPs.