CoPay Accumulator Programs Report.
Industry stakeholders are all working to reduce spending for specialty drugs. A pharmacy benefit manager program that has been gaining increasing notoriety in 2018 are “copay accumulator” programs 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.
To ensure specialty medicines are affordable, drug manufacturers provide copay coupons that patients apply at the pharmacy counter to significantly lower their out-of-pocket costs. Traditionally, insurers and PBMs counted the value of manufacturer coupons towards a patient’s deductible.
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’s April 2018 report answers the following:
- How do PBMs generate revenue?
- Define prescription copayment coupons?
- What are Patient Assistance Programs?
- What are copay accumulators?
- Which PBMs offer copay accumulator programs?
- What are Pharma’s recent comments on accumulator programs?
AMI’s April 2018 report, 40 pages, Table of Contents:
Pharmacy Benefit Managers – pgs. 4-8
- Revenue Generation
- Copay Accumulator Programs
- Patient Assistance Programs
PBM Profiles and Accumulator Programs – pgs. 9-30
- Araya Pharmacy Benefit Management
- CVS Health
- Express Scripts, Inc.
- HealthSmart Rx Solutions
- MedImpact Healthcare Systems
- Prime Therapeutics
- Script Care, Ltd.
Pharma Comments on Accumulator Programs – pgs. 31-39
- Intercept Pharmaceuticals
- Eli Lilly and Company
- OptiNose US, Inc.
References – pg. 40
Published: April 23, 2018