Patients in Missouri Urge Passage of New Bill to Ensure All Copays Count

Health Policy Reform Supports Patient Access to Critical Medication by Banning Discriminatory Copay Accumulator Adjustment Programs

December 6, 2023

JEFFERSON CITY, Mo. – Patients from across Missouri, and Missouri’s leading patient advocacy organizations today thanked Representative Wright and Senators Bernskoetter, Fitzwater, and Eslinger for introducing legislation that would require more health insurance plans to count all prescription drug copayments made by or on behalf of Missourians.

The important health policy reform would prevent an increasingly common practice used by insurance companies and pharmacy benefit managers called “copay accumulator adjuster programs” that prevent prescription drug copay assistance from counting towards a patient’s deductible or out-of-pocket maximum.

Accumulator programs subvert assistance meant to support patients. Increasingly, insurers no longer count assistance that patients use to help afford their prescriptions toward the patient’s deductible and out of pocket costs. When those costs don’t count, patients pay more out of their own pockets.

In Missouri, 80% of health plans on the marketplace feature language preventing patients from accessing copay assistance that counts. For individuals living with rare and chronic conditions, like cancer, hemophilia, arthritis and many more, access to effective treatment is often made possible through copay assistance.

“Many cancer patients have difficulty affording the cost of their prescription drugs and copay accumulator adjustments undercut tools that help them. Missourians who have heard the words ‘you have cancer’, should get the full benefit of the help they need. This legislation means that they once again will” said Emily Kalmer, Missouri government relations director for the American Cancer Society Cancer Action Network.

“Almost every health insurance company in the state says that when a patient finds someone to help her afford her medicine, they will not count that help toward the patient’s deductible or out-of-pocket maximum,” said Bridget Tyrey, Executive Director of Gateway Hemophilia. “Patients who rely on copay assistance to afford their medication need a helping hand – not insurance company roadblocks. We’re incredibly grateful for Representative Wright and Senators Bernskoetter, Fitzwater, and Eslinger for introducing this legislation and call on all of their colleagues to help remove these roadblocks.”

Under copay accumulator adjuster programs, out-of-pocket costs are paid twice, first from copay assistance and then from the patient. The legislation pre-filed for the 2024 legislative session would stop that discriminatory practice and protect patients.


Members of the Missouri All Copays Count Coalition include:

The AIDS Institute

Aimed Alliance

Alliance for Patient Access

ALS Association

American Cancer Society Cancer Action Network

American Diabetes Association

Arthritis Foundation

Association for Clinical Oncology

Asthma & Allergy Foundation of America-Mid States

Coalition of State Rheumatology Organizations

Chronic Disease Coalition

Every Life Foundation

Gateway Hemophilia Association

Hemophilia Federation of America

Immune Deficiency Foundation

Lupus and Allied Diseases Association, Inc.

Midwest Hemophilia Association

Missouri Academy of Family Physicians

Missouri Association of Osteopathic Physicians & Surgeons

Missouri Oncology Society

Missouri State Medical Association

The National Bleeding Disorders Foundation

National Eczema Association

National Multiple Sclerosis Society

Spondylitis Association of America

Susan G. Komen



About ACS CAN 

The American Cancer Society Cancer Action Network (ACS CAN) makes cancer a top priority for policymakers at every level of government. ACS CAN empowers volunteers across the country to make their voices heard to influence evidence-based public policy change that improves the lives of people with cancer and their families. We believe everyone should have a fair and just opportunity to prevent, find, treat, and survive cancer. Since 2001, as the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN has successfully advocated for billions of dollars in cancer research funding, expanded access to quality affordable health care, and advanced proven tobacco control measures. We’re more determined than ever to stand together with our volunteers to end cancer as we know it, for everyone. Join the fight by visiting

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