Many patients also face a deductible for their prescriptions. See the benefit design data in Employer Pharmacy Benefits in 2017: More Cost-Shifting to Patients As Tiers and Coinsurance Expand. Patients today are being asked to pay a significant share of prescription costs for more-expensive specialty drugs, because of high coinsurance amounts. Is it any wonder that people think their employers and insurance companies are from the dark side? Given the direct human healthcare impact of copay accumulator programs, I don’t see how they can be considered value-based designs. What’s worse, many patients won’t understand their new “benefit.”

Accumulator programs will further lower a plan’s drug spending by discouraging the appropriate utilization of specialty therapies and reducing adherence. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum.Īs you will see below, plan sponsors-employers and health plans-will save big money because accumulators shift a majority of drug costs to patients and manufacturers. Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs-a benefit design option that I expect to become highly controversial this year.Īccumulator programs target specialty drugs for which a manufacturer provides copayment assistance.

Copay assistance programs futurescripts