Addressing the Unintended Consequences of Co-pay Accumulator Adjustment Programs

Pharmaceutical manufacturers sought to improve patient access to treatments through the use of co-payment assistance cards. But, while these cards reduce the out-of-pocket cost for enrollees, employers worry that they could result in increased medication use and associated expenditures, thus negating efforts made with benefit designs. To mitigate the issue, pharmacy benefit managers have introduced co-pay accumulator adjustment programs, which prevent pharmaceutical manufacturer subsidies put toward a patient’s out-of-pocket costs from counting toward the deductible. As a result, high-deductible health plan enrollees could face a sharp spike in out-of-pocket costs when the manufacturer subsidy limits are reached, but the patient has not reached their deductible.

Despite the lack of data around how these programs affect patient outcomes, they have become popular among employers.

Bruce Sherman, MD, FCCP, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions, discusses the findings of a paper in the July issue of The American Journal of Managed Care^® on the impact of co-pay accumulator adjustment programs on specialty drug use.

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