This chart highlights the state laws related to co-pay accumulator programs. Check back often, as this chart is updated frequently.
If you have a self-funded plan, certain state laws may not apply. For information on how to determine if your plan is self-funded, see our blog post.
For more health insurance information, visit our Health Insurance Materials & Resources.
| State | Has Laws Limiting Co-Pay Accumulator Programs | |
|---|---|---|
| ALABAMA | ||
| ALASKA | ||
| ARIZONA | Requires health insurers and pharmacy benefit managers to count the value of contributions made by or on behalf of enrollees toward enrollees’ cost-sharing requirements (e.g., out-of-pocket maximum, deductible, copayment, coinsurance) for prescription drugs that either 1) do not have generic equivalents; or 2) do have generic equivalents, but the enrollee obtained access to the prescription drug through: Prior authorization; Step therapy; or The health insurer’s exceptions and appeals process. | https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/20/01126.htm |
| ARKANSAS | Requires any cost-sharing paid by or on behalf of the enrollee to count toward the enrollee’s applicable cost-sharing requirement. Excludes cost-sharing for a brand drug if the brand drug is A.) not considered to be medically necessary by the prescriber; and B.) has a medically appropriate generic equivalent. | https://arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2021R%2FPublic%2FACT965.pdf |
| CALIFORNIA | ||
| COLORADO | Requires a health insurer or pharmacy benefit manager to include in the calculation of a covered person's contributions toward cost-sharing requirements any payments made by or on behalf of the covered person for a prescription drug if: (A) the prescription drug does not have a generic equivalent or biosimilar drug or (B) the prescription drug does have a generic equivalent or biosimilar drug but the covered person received prior authorization, used step-therapy protocol, or otherwise received approval from the carrier or PBM. | https://leg.colorado.gov/bills/sb23-195 |
| CONNECTICUT | Requires health carriers, pharmacy benefit managers, and managed care organizations to count any discounts or payment made by a third party on behalf of a plan enrollee toward the enrollee’s coinsurance, copayment, deductible, and other out-of-pocket expenses for a covered prescription drug benefit. | https://www.cga.ct.gov/2021/ACT/PA/PDF/2021PA-00014-R00SB-01003-PA.PDF |
| DELAWARE | Requires health insurance carriers and pharmacy benefits managers to include cost-sharing contributions paid by or on behalf of the enrollee when calculating any enrollee cost-sharing requirement. "Cost-sharing requirement" is defined as any copayment, coinsurance, deductible, or annual limitation on cost-sharing required in order to receive health care services, including prescription drugs. | https://legis.delaware.gov/json/BillDetail/GenerateHtmlDocumentEngrossment?engrossmentId=25174&docTypeId=6 |
| FLORIDA | ||
| GEORGIA | Requires pharmacy benefit managers to include any amount paid by or on behalf of the patient (e.g., payment, financial assistance, discount, or product voucher) for a prescription drug when calculating a patient’s contribution to any out-of-pocket maximum, deductible, or copayment responsibility, if: The drug does not have a generic equivalent; OR The drug does have a generic equivalent but was obtained through prior authorization, a step therapy protocol, or the insurer’s exceptions and appeals process. | https://www.legis.ga.gov/legislation/56907 |
| HAWAII | ||
| IDAHO | ||
| ILLINOIS | Requires health plans to apply any contributions (i.e., third-party payments, financial assistance, discount, product vouchers, or any other reduction in out-of-pocket expenses) for prescription drugs made by or on behalf of an enrollee toward that person’s deductible, copay, or cost-sharing responsibility, or out-of-pocket maximum. The law does not distinguish between prescription drugs that do or do not have generic equivalents, and therefore, applies to both. | https://www.ilga.gov/legislation/publicacts/101/101-0452.htm |
| INDIANA | Requires an insurer, an administrator, and a pharmacy benefit manager to apply the annual limitation on cost sharing set forth in the federal Patient Protection and Affordable Care Act to prescription drugs that: (1) are covered under a health plan; (2) are life-saving or intended to manage chronic pain; and (3) do not have an approved generic version. Applies to health plans that are issued, delivered, amended, or renewed after December 31, 2025. | https://iga.in.gov/legislative/2025/bills/house/1604/details |
| IOWA | Requires pharmacy benefits managers to include any amount paid by a covered person, or on behalf of a covered person, when calculating the covered person's total contribution toward the covered person's cost-sharing. Applies to pharmacy benefits managers, health carriers, third-party payers, and health benefit plans that manage a prescription drug benefit in the state on or after July 1, 2025. | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=SF383 |
| KANSAS | ||
| KENTUCKY | Prohibits health plans and pharmacy benefit managers from excluding any cost-sharing amounts paid by or on behalf of an enrollee for a prescription drug when calculating the enrollee’s total contribution toward any applicable cost-sharing requirements. Note that this requirement does not apply in the case of a brand prescription drug for which a generic alternative is available, unless the enrollee has obtained access to the brand prescription drug through prior authorization, a step therapy protocol, or the insurer’s exception and appeals processes. | https://apps.legislature.ky.gov/record/21RS/sb45.html |
| LOUISIANA | Defines cost-sharing requirement to include amounts required by and on behalf of an enrollee. Requires health insurers to include any cost-sharing amounts paid by or on behalf of the enrollee when calculating an enrollee’s contribution toward any applicable cost-sharing requirement. | https://legis.la.gov/legis/BillInfo.aspx?s=21RS&b=SB94&sbi=y |
| MAINE | Defines cost-sharing requirement to include amounts required by and on behalf of an enrollee. Requires health insurers to include any cost-sharing amounts paid by or on behalf of the enrollee when calculating an enrollee’s contribution toward any applicable cost-sharing requirement. Excludes medications with generic equivalents. Requires third-party assistance programs to notify patient within 7 days of the total amount of assistance available. | http://www.mainelegislature.org/legis/bills/display_ps.asp?PID=1456&snum=130&paper=&paperld=l&ld=1783#C-Pace%20committee%20vote.docx |
| MARYLAND | Requirs insurers and pharmacy benefit managers to include any discount, financial assistance payment, product voucher, or other out–of–pocket expense made by or on behalf of the insured or enrollee for a prescription drug in the insured’s or enrollee’s coinsurance, copayment, deductible, or out–of–pocket maximum. Note that this requirement does not apply in the case of a brand prescription drug for which a generic alternative is available, unless the enrollee has obtained access to the brand prescription drug through prior authorization, a step therapy protocol, or the insurer’s exception and appeals processes. Takes effect January 1, 2026 and remains effective for a period of 3 years and 6 months. At the end of July 1, 2029, this Act, with no further action required by the General Assembly, shall be abrogated and of no further force and effect. | https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0773?ys=2025RS |
| MASSACHUSETTS | ||
| MICHIGAN | ||
| MINNESOTA | ||
| MISSISSIPPI | ||
| MISSOURI | ||
| MONTANA | ||
| NEBRASKA | ||
| NEVADA | Has regulations stating that a carrier is not allowed to exclude Rx coupons from cost-sharing limits except in situations where a generic is available. | https://aimedalliance.org/wp-content/uploads/2024/05/PY25_NVMED_-Filing-Guidance.pdf#page=50 |
| NEW HAMPSHIRE | ||
| NEW JERSEY | ||
| NEW MEXICO | Requires the insurer to credit the enrollee for the full value of any discounts provided or payments made by third parties at the time of the prescription drug claim when calculating an enrollee’s cost-sharing obligation for covered prescription drugs. | https://nmlegis.gov/Legislation/Legislation?Chamber=S&LegType=B&LegNo=51&year=23 |
| NEW YORK | Requires health plans and pharmacy benefit managers to count manufacturers’ discounts toward a person’s cost-sharing maximum calculation. Application of the copay accumulator is limited to brand-name drugs without a generic equivalent; or with a generic equivalent that are accessed through prior authorization or appeals; and all generic drugs. | https://www.nysenate.gov/legislation/bills/2023/S1350 |
| NORTH CAROLINA | The law requires that insurers or pharmacy benefit managers count amounts paid by the insured or on the insured’s behalf towards an insured’s out-of-pocket maximum, deductibles, copayments, coinsurance, or other applicable cost-sharing requirements for drugs that either have no generic equivalent or have a generic equivalent but has obtained authorization for the drug through prior authorization, a step therapy protocol, or the exception and appeals processes. | https://www.ncleg.gov/Sessions/2021/Bills/Senate/PDF/S257v6.pdf |
| NORTH DAKOTA | Requires health plans to include any amount paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement for a drug for which a prescription is required: (1) Without a generic equivalent; or (2) With a generic equivalent, if the enrollee has obtained access to the drug through prior authorization, a step therapy protocol, or the heath care insurer's expectations and appeals process.Becomes effective January 1, 2026. | https://ndlegis.gov/assembly/69-2025/regular/bill-index/bi1216.html |
| OHIO | ||
| OKLAHOMA | Deems it an unfair claim settlement practice in violation of the Unfair Claims Settlement Practice Act if a health insurer or pharmacy benefit manager fails to include any amount paid by or on behalf of an enrollee toward the enrollee’s out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing requirement. | https://www.oklegislature.gov/BillInfo.aspx?Bill=hb2678&Session=2100 |
| OREGON | Requires an insurer, a pharmacy benefit manager and a health care service contractor to count payments made by or on behalf of an enrollee for the costs of certain prescription drugs when calculating the enrollee's contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other required cost-sharing for the drugs. | https://olis.oregonlegislature.gov/liz/2024R1/Measures/Overview/HB4113 |
| PENNSYLVANIA | ||
| RHODE ISLAND | ||
| SOUTH CAROLINA | ||
| SOUTH DAKOTA | ||
| TENNESSEE | Defines “cost-sharing requirement” to include copayment, coinsurance, deductible, or annual limitation on cost sharing required by or on behalf of a plan enrollee. Requires insurers to include cost-sharing amounts paid by or on behalf of an enrollee when calculating the enrollee’s contribution to an applicable cost-sharing requirement. | https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB0619&ga=112 |
| TEXAS | Requires health benefit plans and pharmacy benefit managers to apply any third-party payment, financial assistance, discount, product voucher, or other reduction in out-of-pocket expenses made by or on behalf of an enrollee for a prescription drug to the enrollee’s deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum applicable to health benefits under the enrollee’s plan. This is limited to a reduction in out-of-pocket expenses for a prescription drug covered by the enrollee’s health benefit plan for which: (1) a generic equivalent does not exist or (2) a generic equivalent exists but enrollee has prior authorization, used step therapy protocol, or obtained access using health plan’s exceptions or appeals process. | https://capitol.texas.gov/BillLookup/History.aspx?LegSess=88R&Bill=HB999 |
| UTAH | ||
| VERMONT | A pharmacy benefit manager shall attribute any amount paid by or on behalf of a covered person toward the covered person’s deductible, if any, and the annual out-of-pocket maximums applicable to the covered person’s health benefit plan. Third-party payment, financial assistance, discount, coupon, or other reduction in out-of-pocket expenses made on behalf of a covered person shall only apply to a prescription drug: (i) for which there is no generic drug or interchangeable biological product; or (ii) for which there is a generic drug or interchangeable biological product, but for which the covered person has obtained access through prior authorization, a step therapy protocol, or the pharmacy benefit manager’s or health benefit plan’s exceptions and appeals process. | https://legislature.vermont.gov/bill/status/2024/H.233 |
| VIRGINIA | Requires health plans to include any amount paid by or on behalf of a plan enrollee when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement to the extent permitted by federal law and regulation. Prohibits HDHP from using copay assistance until minimum deductible is met. | https://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+SB1596 |
| WASHINGTON | Requires health plans and pharmacy benefits managers to include any amount paid by or on behalf of a plan enrollee when calculating an enrollee’s contribution to any applicable cost-sharing requirements. | https://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Session%20Laws/Senate/5610-S.SL.pdf?q=20250822104546 |
| WEST VIRGINIA | Requires health plans and pharmacy benefits managers to include any amount paid by or on behalf of a plan enrollee when calculating an enrollee’s contribution to any applicable cost-sharing requirements. The law does not distinguish between prescription drugs that do or do not have generic equivalents, and therefore, applies to both. | http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=HB2770%20SUB%20ENR.htm&yr=2019&sesstype=RS&billtype=B&houseorig=H&i=2770 |
| WISCONSIN | ||
| WYOMING | ||
| PUERTO RICO | Requires insurers and pharmacy benefit managers to include any payment, discount, or item that is part of a financial assistance program, discount plan, coupon, or any contribution offered to the insured by the manufacturer in the calculation of the patient’s contribution, out-of-pocket expenses, copayments, coinsurance, deductible, or in compliance with the contribution-sharing requirements. | https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:29f92004-baad-4aa3-917f-927908f0d5ce |
| LAST UPDATED | 08/2025 |