Copay Adjustment Programs: What Are They and What Do They Mean for Consumers?

(By Michelle Long, Meghan Salaga, and Kaye Pestaina for The Kaiser Family Foundation Published: Oct 24, 2024)

Americans spend on average more than $1,000 per person per year on prescription drugs, far surpassing prescription drug spending in other peer nations. According to a 2023 KFF poll, 3 in 10 adults taking prescription drugs report that they have not taken their medication as prescribed due to costs. In a 2023 KFF consumer survey, nearly one-quarter (23%) of insured adults reported that their health insurance did not cover a prescription drug or required a very high copay for a drug that a doctor prescribed, increasing to more than one-third (35%) of insured adults in fair or poor physical health. People who need specialty or brand-name medications to treat chronic health conditions such as diabetes, cancer, arthritis, and HIV are especially vulnerable to high costs, particularly considering rising deductibles over the years. In addition, plans are more likely to apply coinsurance (a percentage of the cost paid by the enrollee after meeting their deductible) than copayments (a flat dollar amount) for specialty or higher cost prescription drugs than they are for lower cost drugs, which could result in enrollees having to pay more out of pocket for these drugs. Continue reading here…

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