It's Valentine’s Day—and commercial plan sponsors remain smitten with copay accumulators and maximizers.
Our latest update finds that as of late 2023, about half of commercial lives were in plans that utilize a copay accumulator and/or a maximizer. These programs’ growth continues to divert the value of a manufacturer’s copay support payments away from patients and toward plans and PBMs. Check out the data below.
Patient advocacy groups and some big legal wins are starting to reverse Cupid’s arrow. But given the money at stake, I suspect that plans will keep looking for love in all the wrong places.
This article is adapted from Chapter 6 of our forthcoming 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. Additional details will be available in the full report.
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Benefit designs have been shifting drug costs to patients, some of whom are now responsible for a much greater share of their prescription costs. These out-of-pocket expenses can be quite high, especially for more expensive specialty drugs when patients face coinsurance amounts and payment in the deductible coverage phase.
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