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Are Copay Accumulator Programs Helping Manage Costs or Limiting Patient Access?

As the drive to improve drug costs and coverage for patients continues, payers, pharmacy benefit managers (PBMs), and manufacturers compete to offer cost managing programs. The latest effort from PBMs comes in the form of copay accumulator programs, which seek to limit the impact of manufacturers’ coupons by not counting the value of the coupon toward the patient’s deductible. 

Bruce Feinberg, DO, vice president and chief medical officer at Cardinal Health Specialty Solutions, discussed the copay accumulator program’s barriers and benefits for the patient, provider, and payers during a session the Asembia 2019 Specialty Pharmacy Summit. 

“To understand the copay accumulator program, you have to understand the delicate balance that has been going on now for five decades between those who pay for health care and those who provide the services and products that are being delivered to treat and provide health care,” explained Mr Feinberg. 

Payers, PBMs, and manufactures have made several strides over the years in an attempt to manage costs, comprising the topics below. 

  • Payer/PBMs 
  • Prior authorizations 
  • Precertification 
  • Tiered formularies 
  • Copays 
  • Coinsurance 
  • Manufacturers 
  • Copay coupons 
  • Vouchers 
  • Rebates 
  • Direct-to-consumer marketing 

The intentions behind copay accumulator programs was to help manage costs, however, Mr Feinberg noted several unintended consequences for patients from their introduction. For payers and PBMs, these programs create cost-sharing opportunities of medications, as well expose the implications of higher-priced alternatives, offer patients more choice, and reduce costs. 

However, according to Mr Feinberg, copay accumulator programs actually increase nonadherence and discontinuation of therapy, increasing health care costs. He also mentioned financial toxicity and patient confusion as potential consequences. 

Data from a ConnectiveRx Patient Accumulator Survey showed that only 25% of patients repored being familiar with the term “accumulator adjustment” and 82% of medical oncologists/hematologists have not heard of copay accumulator programs at all. 

Mr Feinberg expressed that the saga of efforts to manage costs will continue but for now, copay accumulator programs are likely here to stay.—Edan Stanley 

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