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Payer Tactics to Manage Commercial Copay Assistance Gaining Traction

By Corey Ford, MHA

Tactics for managing commercial copay assistance are gaining traction. We examine how it’s happening and what to expect.


How are payers managing copay assistance programs?

Manufacturer-sponsored copay assistance programs exist to ease the often significant financial burden on patients. When the cost of specialty therapies can exceed thousands of dollars, this assistance can make all the difference in overcoming affordability and adherence barriers to improve health outcomes.


As more commercial payers assess copay programs for their impact on cost and formulary management, plans and PBMs may target—and restrict—financial assistance. In a new issue brief, Xcenda shares results from a survey of 46 national and regional commercial plans to reveal:

- How many plans are limiting financial assistance now—and how much that number could grow over the next two years

- The therapeutic areas most likely to be targeted by copay assistance restrictions

 - The models payers are using to limit financial assistance

 - The impact for patients and manufacturer programs


About The Author

Corey Ford, MHA
Vice President of Reimbursement and Policy Insights
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