More Commercial Health Plan Enrollees Have Copay Maximizers Than Accumulators in 2024

Copay maximizer programs are gaining popularity among payers while copay accumulators appear to be losing some of their appeal, according to the annual Copay Accumulator & Maximizer Programs Special Report published by AIS Health’s parent company, MMIT. The report was based on surveys of 35 commercial insurers and PBMs representing 121.0 million lives.

About 39% of people were enrolled in plans with copay accumulators in 2024 on average, down from 47% in 2023. And 47% of enrollees were in plans with copay maximizer programs. On average, payers anticipated that about 48% and 57% of plan members will be covered by plans with copay accumulators and maximizers within the next 12 months, respectively.

Both accumulators and maximizers prevent any monetary assistance that pharmaceutical companies offer commercially insured patients, such as copay coupons, from counting toward their deductible or out-of-pocket maximum. Copay accumulators deplete all available assistance as soon as possible, while copay maximizers distribute the total amount of a manufacturer’s copay-offset funds over 12 months, making that amount the new monthly copayment on any given drug over the course of a year.

Over the past few years, state legislators have passed bills aimed at banning the use of copay accumulator programs and ensuring that any third-party copay assistance used by a patient is counted toward the cost-sharing limits of that patient’s plan. As of November 2024, 21 states and Puerto Rico have passed laws banning payer and PBM use of copay accumulator programs, up from 19 states in 2023. The legislation applies to only state-regulated health plans, including individual, fully insured large group and small group plans.

Health plans surveyed by MMIT said they commonly countered bans on copay accumulator programs by negotiating with manufacturers (56% of covered lives) and lobbying at a federal level (49% of covered lives) in 2024.

A U.S. district court ruled in September 2023 that manufacturer copayment assistance must be counted toward commercially insured patients’ out-of-pocket costs unless a brand-name drug has a medically appropriate generic equivalent. While some payers surveyed by MMIT agreed with the ruling, many were concerned that it would drive up costs for insurers. So far, the Biden administration has not issued regulations to enforce the district court’s ruling.

The final 2025 Notice of Benefit and Payment Parameters (NBPP) prohibited the use of copay maximizers in non-grandfathered individual and small group market plans, but it remained silent on copay accumulators. HHS also did not address copay accumulators in the proposed 2026 NBPP, but HHS said that it and the Labor and Treasury departments plan to issue a future notice of proposed rulemaking that addresses “the applicability of drug manufacturer support to the annual limitation on cost sharing.” This omission leaves uncertainty about copay assistance programs and may lead to issues with patient adherence, payers told MMIT. However, they did not anticipate a shift back to accumulator programs as maximizers were seen as more valuable.

This infographic was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.