Managing the Growing Expansion of Copay Accumulators

By Corey Ford, MHA |

Over the past two years, pharmacy benefit managers (PBMs) and commercial health plans have launched copay accumulator adjustment programs, an insurance design with potential adverse impacts on patients’ adherence to prescribed therapy regimens. We explore recent trends around copay accumulators, the impact on patients, and solutions for consideration.

ISSUE BRIEF

Rolling Back the Tide: Deploying a Consultative Approach to Tackle the Growing Expansion of Copay Accumulators

Over the past 2 years, pharmacy benefit managers (PBMs) and commercial health plans have launched copay accumulator adjustment programs, an insurance design with potential adverse impacts on patients’ adherence to prescribed therapy regimens. Copay accumulator adjustment programs exclude the use of manufacturer sponsored commercial copay assistance from a patient’s accrual of out-of-pocket (OOP) expenses throughout a plan benefit year.

The leading PBMs by market share—Express Scripts, CVS Caremark, and OptumRx—have all saturated the marketplace with copay accumulators for products in select therapeutic areas, primarily by shopping the design to large, self-funded employer plans. In this issue brief, Xcenda and Lash Group explore recent trends around copay accumulators, the impact on patients, and solutions for consideration.


About the Author

Corey Ford

Corey Ford, MHA

Director, Reimbursement & Policy Insights
Xcenda
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