Gem State Wire

Idaho is one of thirty states that allows copay accumulators.

That's according to an analysis of National Conference of State Legislatures data by Gem State Wire.

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.

Idaho does not require insurers to count all payments made by patients, even those from patient assistance programs, toward the patient’s out-of-pocket maximum.

Opponents of copay accumulators, such as Bridget Tyrey, executive director of the Gateway Hemophilia Association (GHA) in St. Louis, Mo, say that copay accumulators cause patients to “basically pay twice, first with their copays assistance card, second from the patient."

While some health insurers say copay accumulator bans would result in higher insurance premiums, a May 2023 analysis by The AIDS Institute found "no evidence that enacting a copay accumulator adjustment ban has a meaningful impact on average premiums." That analysis looked at 16 states that banned CAAPS between 2019 and 2022.

Julie Gull Sheffield, who works with the group, Patients Come Firs,, said that copay assistance is a “critical resource” to provide patients the “assistance they need to access medications,” but that “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.”

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Which states ban copay accumulators?

Source: National Conference of State Legislatures

State Name	Ban on Copay Accumulators?
Alabama	No
Alaska	No
Arizona	Yes
Arkansas	Yes
California	No
Colorado	Yes
Connecticut	No
Delaware	No
District of Columbia	Yes
Florida	No
Georgia	Yes
Hawaii	No
Idaho	No
Illinois	Yes
Indiana	No
Iowa	No
Kansas	No
Kentucky	Yes
Louisiana	No
Maine	Yes
Maryland	No
Massachusetts	No
Michigan	No
Minnesota	No
Mississippi	No
Missouri	No
Montana	No
Nebraska	No
Nevada	No
New Hampshire	No
New Jersey	No
New Mexico	Yes
New York	Yes
North Carolina	Yes
North Dakota	No
Ohio	No
Oklahoma	Yes
Oregon	No
Pennsylvania	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	Yes
Texas	Yes
Utah	No
Vermont	Yes
Virginia	Yes
Washington	Yes
West Virginia	Yes
Wisconsin	No
Wyoming	No