UnitedHealthcare is facing a class-action lawsuit, which alleges the insurer inappropriately stopped crediting payments funded by drug manufacturer assistance toward a member’s deductible and out-of-pocket limit, according to a Sept. 30 complaint in a Connecticut federal court.
The complaint, from a UnitedHealthcare member, said his plan has a $7,550 deductible and annual out-of-pocket limit before coverage obligations kick in, but the plan does not specify who must pay the $7,550.
The manufacturer of the member’s chronic psoriasis drug offers a copay assistance program. While UnitedHealthcare counted the manufacturer’s copay assistance in 2025, the payer pivoted in 2026 and stopped crediting payments from the program toward cost-sharing requirements, according to the lawsuit.
This practice is known as a “copay accumulator” rule, wherein an insurance plan blocks applying drug manufacturer discount coupons toward an annual deductible or out-of-pocket maximum. The plaintiff said UnitedHealthcare has accepted more than $26,000 in copay assistance, with none of that going toward his deductible.
“This new practice is not authorized or agreed-to anywhere in UHC’s certificates of coverage,” the complaint said.
The counts center on improper denial of benefits and a breach of fiduciary duty. The plaintiff points to the ACA and a Connecticut law that requires health plans to credit third-party discounts for coinsurance, copayments or deductibles. The complaint seeks a declaration that the practice is wrongful, as well as reimbursement.
Becker’s has reached out to UnitedHealthcare for comment and will update this story if more information becomes available.
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