![]() This trend underscores the need for copay assistance to help alleviate the financial burden of high OOP costs.Īs the utilization of copay assistance has skyrocketed over the last decade, a growing number of commercial health plans are deploying copay accumulators or copay maximizers, which exclude the use of copay assistance from the patient's OOP cost accrual or calculation. To manage this cost, both commercial and health insurance exchange plans have adapted their benefit designs to require greater cost-sharing for specialty pharmaceuticals. Insights from an Xcenda Managed Care Network survey conducted over the last three years reveal that commercial health plans identify specialty drugs as a key cost driver. How could the impact of these tactics impact patient adherence? What operational solutions should manufacturers consider for mitigating the potential negative effects on patients? Payers' cost control efforts ![]() In recent years, however, many payers have adopted copay accumulator programs that block a manufacturer's copay support from applying to the patient's deductible or out-of-pocket accrual. Traditionally, this financial assistance counted toward a patient's OOP cost accrual for the purposes of exhausting the deductible and hitting the plan OOP maximum, with the insurance plan covering subsequent prescription costs once the patient reaches the annual limit. As a result, patients are increasingly relying on manufacturer-sponsored copay assistance to help cover the cost of their medications, particularly for specialty drugs. Over the last decade, commercial health insurance plans have placed more of the cost-sharing burden on patients via higher out-of-pocket (OOP) obligations.
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