Understand The Issues
Copay Accumulators
A 2023 Texas law requires health plans to count Texans' copays toward their required deductible or out-of-pocket maximum.
Copay Maximizers
With copay accumulators against Texas law, more insurers are using "copay maximizers" to penalize people using patient assistance.
Medication Switching
Medication Switching
Health insurers and PBMs often switch patients off their prescribed medications for non-medical, purely financial reasons.
Prior Authorizations
Medication Switching
Though the 2021 Texas "gold card" law is improving prior authorization burdens that often delay patient care, more work remains.
Step Therapy
Texas passed a law in 2017 to allow medical providers to appeal insurers' step therapy requirements and receive a timely response.
Essential Health Benefits
Federal law requires health insurers to cover "essential health benefits," yet many health plans and PBMs have found a loophole.