Health Insurance State Laws:
Co-Pay Accumulators

This chart highlights the state laws related to co-pay accumulators. 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.

If you don't find what you're looking for, see our other Charts of Health Insurance State Laws:

For more health insurance information, visit our Health Insurance Materials & Resources. If you are looking for information on Medicare or Medicaid, return to the main state laws page.

StateHas Laws Limiting Co-Pay Accumulator Programs
ALABAMA
ALASKA
ARIZONARequires 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://legiscan.com/AZ/text/HB2166/2019
ARKANSASRequires 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://legiscan.com/AR/drafts/HB1569/2021
CALIFORNIA
COLORADORequires 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 PBMThis act applies to health benefits plans issued or renewed on or after January 1, 2025https://leg.colorado.gov/bills/sb23-195
CONNECTICUTRequires 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
DELAWARERequires 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
GEORGIARequires 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
ILLINOISRequires 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
IOWA
KANSAS
KENTUCKYProhibits 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://legiscan.com/KY/text/SB45/id/2228715
LOUISIANADefines 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
MAINEDefines 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
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICORequires 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. Beginning on or after January 1, 2024, an insurer cannot charge a different cost-sharing amount for: (1) prescription drugs obtained at a non-affiliated pharmacy; or (2) administration of prescription drugs at different infusion siteshttps://nmlegis.gov/Legislation/Legislation?Chamber=S&LegType=B&LegNo=51&year=23
NEW YORKRequires health plans and pharmacy benefit managers to count manufacturers’ discounts toward a person’s cost-sharing maximum calculation. Application of the copayaccumulator is limited to brand-name drugs without a generic equivalent; or with ageneric equivalent that are accessed through prior authorization orappeals; and all generic drugs.https://www.nysenate.gov/legislation/bills/2023/S1350
NORTH CAROLINAThe 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.https://www.ncleg.gov/Sessions/2021/Bills/Senate/PDF/S257v6.pdf
NORTH DAKOTA
OHIO
OKLAHOMADeems 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://legiscan.com/OK/text/HB2678/2021
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEEDefines “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://legiscan.com/TN/text/HB0619/2021
TEXASRequires 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
VIRGINIARequires 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
WASHINGTONRequires 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://custom.statenet.com/public/resources.cgi?id=ID:bill:WA2021000H1713&ciq=ncsldc3&client_md=7fcceca4259af8b53f35bbb9bf277adf&mode=current_text
WEST VIRGINIARequires 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 RICOxhttps://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:29f92004-baad-4aa3-917f-927908f0d5ce
LAST UPDATED10/2023

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