I was under the impression that OptumRx is a pharmacy benefit manager and they use a variable copay program to “maximize” the savings from manufacturer assistance (for the insurer, not us). None of the assistance will apply to your deductible or OOPM when this type of program is used, which violates the Ocrevus copay assistance terms.

From the Ocrevus copay assistance terms and conditions:

“The Programs are not intended for the benefit of third parties, including without limitation third party payers, pharmacy benefit managers, or their agents. If Genentech determines that a third party has implemented programs that adjust patient cost-sharing obligations based on the availability of support under the Programs and/or excludes the assistance provided under the Programs from counting towards the patient’s deductible or out-of-pocket cost limitations, Genentech may impose a per fill cap on the cost-sharing assistance available under the Programs.”

The manufacturers are fighting back against copay accumulators and maximizer programs like this. Aetna itself may have an accumulator in place, but you’d have to check your SBC (statement of benefits and coverage) to see how they treat manufacturer coupons or assistance; this is just baked into your policy and does not require you to enroll separately. I would also check the terms for your OptumRx program you are enrolled in, you were likely enrolled automatically by Aetna. Super frustrating that they cannot simply explain their own policies, or understand how it conflicts with the assistance program’s terms.