New Jersey becomes 26th state to require copay assistance count toward patient cost limits
New Jersey is the 26th state to require copay assistance to count toward patients' cost-sharing limits, but the laws do not cover self-funded employer plans.
New Jersey has become the 26th state to enact a law requiring that copay assistance count toward a patient's cost-sharing limits, according to an analysis of copay accumulator and maximizer programs published by Drug Channels [1]. With New Jersey's law in place, the states with such requirements cover an estimated 17 percent of the US commercial insurance market, or more than 34 million people, for 2025 [1].
The figures come from Drug Channels' review of copay accumulators and maximizers in 2025, which the analysis describes as popular, profitable and problematic [1]. Under an accumulator program, copay assistance — money a drugmaker provides to reduce what a patient pays at the pharmacy counter — does not count toward that patient's deductible or annual out-of-pocket maximum [1]. The state laws in question require the opposite: that the value of the assistance be applied to the patient's cost-sharing limits [1].
One limit on the reach of these laws is built in. They do not apply to self-funded employer plans [1]. That means employees whose coverage is paid for directly by their employer do not get the state-law protection, even when they live in one of the 26 states [1].
Several details about New Jersey's law have not been reported, including its effective date and how the requirement will be enforced. The Drug Channels figures are also an estimate of the share of the commercial market covered by the 26 state laws and are given for 2025 [1]; the analysis does not break out how many New Jersey residents are affected on their own. The report does not address how these rules interact with any specific medication's copay assistance program.
Why it matters for patients
For a patient, the practical difference shows up in how quickly they move through their plan's deductible and annual out-of-pocket maximum. Where copay assistance counts toward those limits, the money spent on the patient's behalf pulls them closer to the point where the plan picks up most of the cost [1]. Where it does not count, a patient can use up a copay card or assistance program and still owe the full deductible later in the year [1].
Because the state laws do not reach self-funded employer plans, two people in the same state — even two coworkers at different employers — can face different rules for the same prescription [1]. Whether a particular prescription's assistance counts depends on how the plan is designed and on whether the coverage is state-regulated or self-funded [1].
People taking GLP-1 medications such as semaglutide (Ozempic, Wegovy, Rybelsus) or tirzepatide (Mounjaro, Zepbound) are subject to the same plan rules as anyone else filling a prescription. The analysis does not say how many GLP-1 users are affected by accumulator programs, or how much of the assistance that manufacturers offer for these drugs is currently excluded from cost-sharing limits; that has not been reported [1].
What happens next
New Jersey's law brings the count of states with these requirements to 26 [1]. The report does not list which states may be considering similar legislation, and no effective dates beyond the 2025 market figures are given [1]. Patients who want to know whether their own coverage uses an accumulator design can check their plan documents or ask their plan administrator, since the answer depends on the type of plan rather than on the state alone [1].
Sources
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