New Jersey becomes the 26th state to enact an anti-copay-accumulator law

New Jersey has enacted a law banning copay accumulator programs, becoming the 26th state to require that manufacturer copay assistance count toward a patient's deductible and out-of-pocket maximum, according to Drug Channels ^[1]. With New Jersey's addition, these anti-accumulator laws now cover an estimated 17 percent of the US commercial insurance market, or more than 34 million people, based on 2025 figures ^[1].

Copay accumulator programs let insurers or pharmacy benefit managers accept a drugmaker's copay card to cover a patient's cost at the pharmacy counter, but then exclude that value when calculating how much the patient has paid toward their deductible or annual out-of-pocket limit ^[1]. A related tool, the copay maximizer, spreads the value of manufacturer assistance across the plan year to offset the patient's monthly cost share, but it too can leave patients owing more once the assistance runs out ^[1]. Drug Channels describes both practices as "popular, profitable, and problematic" for the insurance industry and for patients who rely on brand-name drugs with high list prices ^[1].

The state laws that ban accumulators do not apply to self-funded employer health plans, which are regulated under federal law rather than state insurance law ^[1]. Self-funded plans cover a large share of workers with employer coverage, so even in states with a ban, some patients working for large employers may still be enrolled in a plan that uses an accumulator or maximizer ^[1].

Why it matters for patients

People who take expensive brand-name medications, including GLP-1 drugs sold as Ozempic, Wegovy, Mounjaro, and Zepbound, sometimes use manufacturer copay cards to lower what they pay at the pharmacy. Whether that copay card money also counts toward a deductible or out-of-pocket maximum depends heavily on where a patient lives and what kind of health plan they have.

In New Jersey and the 25 other states with anti-accumulator laws, commercially insured patients who are not in a self-funded plan should now have copay assistance applied to their deductible and out-of-pocket totals ^[1]. That can mean reaching the out-of-pocket maximum sooner and paying less overall during the plan year.

In the roughly two dozen states without such a law, or for anyone in a self-funded employer plan regardless of state, an accumulator or maximizer program may still apply. In those cases, using a copay card can lower the price at the counter without reducing progress toward the deductible, which means the patient could still face a large bill later once the assistance is exhausted ^[1]. Because the rules vary by state and by plan type, patients cannot assume their situation matches their neighbor's, and coverage details are typically found in a plan's benefit summary or by asking a benefits administrator.

What happens next

Drug Channels reports that copay accumulator and maximizer programs remain widespread and profitable for payers as of 2025, even as more states pass bans ^[1]. The source does not list additional states with pending legislation or give a timeline for further changes, so it is not yet known how many more states might act next or when. It is also not yet known from this source whether federal action is being considered that would extend similar protections to self-funded plans, which currently fall outside the reach of the state laws ^[1].