San Jose Standard

The head of a California health care reform group said that copay accumulators are blocking patients from getting discounts on their prescription drugs.

“California is lagging on ensuring patients can receive the assistance they need to access medications,” wrote Julie Gill Shuffield, executive director of Patients Come First-California (PCF-CA), in a Mercury News letter to the editor. “Copay assistance is one critical resource, but often copay accumulators are used to block those discounts from helping patients by not allowing it to count toward a patient’s deductible and out-of-pocket maximums.”

“The consequence for patients with chronic illness can lead to exacerbated symptoms, disease progression and even life-threatening complications without affordable access to medicine,” wrote Gill Shuffield.

A copay accumulator is a program used by some health insurers in the United States that does not count copay assistance payments toward a patient's deductible or out-of-pocket maximum.

Twenty states, plus Washington, D.C. and Puerto Rico, require insurers to count all payments made by patients, even those from patient assistance programs, count toward the patient’s out-of-pocket maximum.

California is not one of those states.

Victoria Killian, a Californian living with ankylosing spondylitis and a member of the Advocacy Committee of the Spondylitis Association of America, wrote in the Los Angeles Daily News on April 25 that copay accumulators cause her to pay for her medications twice.

“Instead of insurance coverage kicking in after patient assistance funds are applied, I found myself responsible for more out-of-pocket expenses than I anticipated,” Killian wrote. “The insurer essentially claimed that, despite paying for my medication using funds from my patient assistance program, I still owed money for medications out of my own pocket until I met my deductible.”

Gill Shuffield, who lives with asthma and said her children have asthma, wrote that “California needs to re-emerge as the leader of patient-friendly reforms while allowing its patients to access innovative medical treatments to live healthier lives.”

Announced as the director of PCF-CA in April, Gill Shuffield previously ran her own firm, Sutter Buttes Advisors, and founded Power of 100 Sutter Buttes Basin, a charitable community women's group. She was named Woman of the Year by U.S. Rep. John Garamendi (D-Fairfield) in 2019. Gill Shuffield also previously worked as director of regulatory and government affairs at AES Corporation and in external affairs for California ISO.