11/23/2023 0 Comments Copay accumulator![]() ![]() PBM abuse of these programs, for their and their payor’s (ETF in this case) financial benefit, jeopardizes the availability of these programs for those who need them. First, manufacturer assistance programs are designed for patients who have little or no insurance. The Coalition had several concerns with this program. The proposal would have financially rewarded the state’s PBM for trying to capture any funds intended for patients that need financial assistance and drawing as many of these dollars down into ETF funds. This plan was rejected by the Board in a 9-2 vote. This was an attempt to capture funds for ETF and Navitus that were intended for patients with little or no insurance coverage. The Coalition worked with members of the Group Insurance Board to rejected a proposal by staff at the Department of Employee Trust Funds (ETF) and their PBM Navitus to enroll Wisconsin employees who are not currently enrolled in a patient assistance program, in a manufacturer patient assistance program. Most recently, the Coalition addressed a Pharmacy Benefit Manager (PBM) proposal, which was defeated by the Group Insurance Board, and a new report that claims accumulator bans don’t impact premiums. In an effort to ensure that all copays count with insurance companies, and address the challenges of Copay Accumulator Adjustors, the Wisconsin All Copays Count Coalition (the Coalition) continues to gain momentum. AugWisconsin All Copays Count Coalition Gains Momentum, Addresses Challenges of Copay Accumulator Adjustors
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