Copay Card Run-Out and Accumulator Impact
When a copay card runs out and the first bill arrives.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Plan type
- Commercial or employer plan
- Drug cost per fill
- 5000 USD
- Fills a year
- 12
- Copay card annual maximum
- 10000 USD
- Plan deductible
- 3000 USD
- Plan coinsurance
- 20 %
- Plan out-of-pocket maximum
- 8000 USD
- Does the plan count the card toward the deductible and out-of-pocket maximum?
- Not known: show both
Result: With an accumulator, the first bill is $200.00 at fill 3, and the patient pays $8,000.00 for the year.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Plan type
- Drug cost per fill (plan price)
- Fills a year
- Copay card annual maximum
- Copay card per-fill maximum
- Plan deductible
- Plan coinsurance
- Plan out-of-pocket maximum
- Does the plan count the card toward the deductible and out-of-pocket maximum?
How this is calculated
Citation
HIV and Hepatitis Policy Institute v. HHS (D.D.C. September 29, 2023) vacated the 2021 version of 45 CFR 156.130(h), which the eCFR still prints, reviving the 2020 rule; whether a plan counts manufacturer assistance depends on the plan and state law. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.