Patients experiencing copay surprise have been observed to be more than 13 times as likely to discontinue therapy as patients who experience consistent copays. This in turn, can prompt patients to discontinue treatment, which may lead to negative health outcomes and drive-up future costs of healthcare 1 (figure 1). This “copay surprise” happens as a patient hits the maximum-allowed manufacturer assistance after their benefit runs out. Many patients under these programs get surprised as they realize they don’t get the copay assistance they had expected and are stuck with a higher bill for their drug than they are used to. For AAPs, the program then disallows the patient copay, which is offset by the manufacturer, to count towards their deductible or out-of-pocket caps. These programs work because the PBMs have visibility through their vertically integrated pharmacy systems to see when a secondary payer (the copay card) is being used. These programs are designed to shift more financial burden indirectly to the manufacturer by extracting more out-of-pocket from the patient. One of the responses to these trends has been the introduction of copay Accumulator Adjuster Programs (AAPs) and copay maximizers by the large Pharmaceutical Benefit Managers (PBMs). The prevalence of this approach is so great that today 95% of branded products offer copay assistance, and approximately 75% of patient cost sharing in the commercial channel, where copay programs are allowed, is now offset by manufacturers. One common mechanism for pharmaceutical manufacturers to help with rising patient costs has been to offer copay offset programs to reduce patient burden. As more patients become exposed to co-insurance and deductibles, and specialty product utilization grows, cost sharing requirements have increased. The more patients are asked to pay, the less likely they are to do so. IQVIA expert, Luke Greenwalt dives in to share how these programs will affect our pharma stakeholders. In this blog series, we will explore the top seven trends we see emerging in 20, and how our customers should respond.Ī major trend we see emerging in 20 are Copay Accumulator Adjuster Programs. It will be important to explore what trends in pharma are developing and how they may impact those working in the industry. As we launch into 2022, it’s time for our stakeholders to look ahead and begin making and adjusting their yearly goals.

Accumulator insurance plan