U.S. health plans are seeing a shift in drug costs from payers to manufacturers and patients and co-pay accumulator programs are responsible. These programs have emerged over the past few years, but have become much more common throughout 2018.
Also known as accumulator adjustments, co-pay accumulator programs no longer count a drugmaker’s payments for specialty drugs toward patients’ deductibles, limiting the financial assistance provided by drug manufacturers in recent years. According to Adam J. Fein, Ph.D., the CEO of Drug Channels Institute, “Normally, a manufacturer’s payments from a copay program count toward a patient’s deductible and annual out-of-pocket maximum. Once these annual limits are reached, the plan pays for all subsequent prescriptions.” Accumulator adjustments make it harder for patients to reach these annual limits.
For example, Accutane, a medication for cystic acne, can cost a patient hundreds of dollars a month. Traditionally, a coupon or discount from the manufacturer would make the medication more affordable and the discount would be applied to the patient’s health insurance deductible, helping reach the patient’s out-of-pocket limit sooner. With accumulator adjustments, the discount is not applied to the deductible.