Industry stakeholders are all working to reduce health plan spend for specialty drugs. Copay accumulator programs were introduced in 2018 by pharmacy benefit managers and promoted to health plans and employers (plan sponsors). The effect of these programs is often to shift the burden of cost for specialty drugs toward patients, who are already experiencing higher deductibles, co-pays, and out-of-pocket maximums.
Prescription copayment coupons are distributed by pharmaceutical companies to reduce patients’ out-of-pocket copayments for specific drugs. When a commercially insured patient uses a coupon to fill a prescription, his or her copay is reduced and the manufacturer pays the balance of the copay. Increasingly, copay accumulators programs are introduced where use of a coupon will not accumulate spending towards a patient’s deductible, which could have significant impact on patients’ ability to afford medicines.
Accumulator programs are often implemented in self-funded employer plans that have high deductibles. Under these programs, only the amount a patient pays at the pharmacy counter — after a manufacturer coupon has lowered the patient’s cost sharing — will count towards their deductible.
AMI has updated its 2018 report to view the impact these programs are having in the market. The report provides background, brief employer and pharmaceutical manufacturer reactions, and the programs being implemented.
AMI’s report answers the following:
- What are copay accumulators?
- Which PBMs offer copay accumulator programs?
- Which employers use these programs?
- What are Pharma’s recent comments on accumulator programs?
- What has been the impact of copay accumulator programs on the market?
The report’s Table of Contents includes:
Copay Accumulator Programs
- Background – pgs. 5-8
- Employers (Walmart, Home Depot) – pg. 9
- Pharma Reaction – pgs. 10-11
PBM Profiles and Accumulator Programs – pgs. 12-34
- AllianceRx Walgreens Prime
- Araya Pharmacy Benefit Management
- CVS Caremark/Aetna
- Express Scripts/Cigna
- HealthSmart Rx Solutions
- MedImpact Healthcare Systems
- Script Care, Ltd.
References – pg. 35