A recent article in the American Journal of Managed Care shed light on copay maximizer strategies among generics manufacturers. But not many patients understand how drug manufacturers are incorporating copay maximizers and accumulators in their reimbursement strategies.
As a widespread challenge for patient access, copay accumulators and maximizers eliminate the altruistic nature of the patient assistance programs. Companies implement these programs to spread out cost-savings for patients over a longer period of time. This leads to the drug manufacturers mitigating cost-sharing burden. Now, the patient is responsible for their deductibles and copays. With an estimated rise in copay maximizers, patients experiencing accumulators may see higher copays.
During the next decade, the industry is expected to expand copay accumulators and maximizer programs. As a result, patients may opt to abandon their therapy when their medication becomes too costly. However, even though copay maximizers distribute the financial responsibility over each month of the year, one potential outcome is that patients may find their health care costs too expensive to continue their treatment.
Recently, the American Society of Clinical Oncology (ASCO) issued a statement opposing copay accumulator and maximizer programs to safeguard patients’ access to care.
Yet, despite this opposition, the Centers for Medicare and Medicaid Services (CMS) announced in their Notice of Benefit and Payment Parameters for 2021 that insurance plans may use these programs starting in 2023. Currently, patients enrolled in federal health programs cannot participate in copay assistance plans. So, while this ruling increases the patient access to copay assistance, implementation of the accumulators and maximizers may not offer enough of a benefit for most patients.
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