North Carolina Becomes Seventh State to Ban Copay Accumulator Adjustment Programs in 2021

Portland, Oregon – September 22, 2021

On September 20, Governor Roy Cooper signed SB 257 into law, making North Carolina the seventh state this year to protect patients from copay accumulator adjustment programs (CAAPs). The legislation, now Session Law 2021-161, includes language to address harmful CAAPs by ensuring all copays count. The National Psoriasis Foundation (NPF) thanks the North Carolina General Assembly and Governor Cooper for taking action to protect people with psoriasis and psoriatic arthritis.

The use of CAAPs by health insurance companies has grown due to a federal rule allowing the exclusion of third-party copay assistance from the out-of-pocket cost calculation. When copay assistance is not counted toward the out-of-pocket maximum, out-of-pocket costs are effectively paid twice. First by the copay assistance, and then by the individual when the assistance runs out. Among individuals with psoriatic disease on commercial insurance who take a biologic medication, 80.3% rely on copay assistance to afford their treatment. Furthermore, among those impacted by a CAAP, nearly half were not aware of the CAAP until they were paying for their treatment at the pharmacy. [1]

To address this growing practice, NPF is a dedicated and active member of the All Copays Count Coalition, a national coalition working across the country to protect patients from CAAPs and advocating to ensure all copays count. With this new law, North Carolina joined six other states that have passed similar legislation to ensure all copays count this year. These states include Arkansas (HB 1569), Connecticut (SB 1003), Kentucky (SB 45), Louisiana (SB 94), Oklahoma (HB 2678), and Tennessee (HB0619 ). In total, 12 states have now protected patients from CAAPs (Arizona, Georgia, Illinois, Virginia, and West Virginia all passed prior to 2021).

“We are thrilled that a dozen states have taken action to protect people with chronic conditions and diseases like psoriatic arthritis and psoriasis from these harmful insurance programs,” said Randy Beranek, President and CEO of NPF. “But our work is not done until all individuals across the country can access and afford the treatments they need to manage their psoriatic disease.”

NPF continues working to improve access to care for the psoriatic disease community at the state and federal level by advocating for policies that reduce out-of-pocket costs and alleviate other barriers to care. To learn more about CAAPs and their impact on people living with psoriatic disease, request this free resource from the NPF Patient Navigation Center. To learn more about the NPF Strategic Plan and efforts to reduce the proportion of individuals diagnosed with psoriatic disease who report difficulties obtaining medical care and treatment due to access barriers, click here.

 About the National Psoriasis Foundation

Serving its community through more than 50 years of patient support, advocacy, research, education and funding, the National Psoriasis Foundation, NPF, is the world’s leading nonprofit fighting for individuals with psoriasis and psoriatic arthritis. The NPF mission is to drive efforts to cure psoriatic disease and dramatically improve the lives of more than 8 million individuals in the United States affected by this chronic immune-mediated disease. As part of that effort, NPF created its Patient Navigation Center to offer personalized assistance to everyone with psoriasis or psoriatic arthritis. To date, NPF has funded more than $28 million in research grants and fellowships that help drive discoveries that may lead to more and better treatments and ultimately a cure. Learn more at


1. 2021 National Psoriasis Foundation Advocacy Survey of Individuals Living with Psoriatic Disease, NPF unpublished data

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