Why Plan Sponsors and PBMs Are Still Falling Hard for Copay Maximizers

Valentine’s Day is almost here! So, it’s time for our romantic review of plan sponsors’ sweetheart: the accumulators and maximizers that divert manufacturers’ copay support payments away from patients—and toward plans and PBMs.

As of late 2024, more than 40% of commercially insured lives were in plans that utilize a copay accumulator or a maximizer. Thanks to a potent combination of payer savings and PBM profits, maximizers are now more beloved than copay accumulators. Check out the data below.

DCI estimates that that plans and their vendors receive about $6.5 billion of manufacturers’ copayment support funds. Given the money at stake, plans will keep wooing this money away from patients. Will legislators let this love continue to bloom? Read on and let me know what you think.

Copay Accumulator and Maximizer Update: Adoption Expands as Legal Barriers Grow (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from February 2024.

---

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.

Copay Accumulator and Maximizer Update: Adoption Expands as Legal Barriers Grow

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.

The Economics of Copay Accumulators, Maximizers, and Alternative Funding Programs (Video) (rerun)

This week, I’m rerunning some popular posts while I put the finishing touches on DCI's new 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

One important update on copay accumulators since my original post from August 2023: U.S. District Court, District of Columbia struck down U.S. Department of Health and Human Services rule allowing non-grandfathered individual and group plans to exclude manufacturers' copay assistance from deductibles. (Details and industry reactions here.) IMHO, this was a huge win for patients thanks to the HIV + Hepatitis Policy Institute, the Diabetes Patient Advocacy Coalition, and the Diabetes Leadership Council.

---

In my most recent video webinar, I explored how plans and PBMs are turning to novel—and highly controversial—benefit design tools that access manufacturers’ patient support spending: copay accumulators, maximizers, and alternative funding programs.

In the video excerpt below, I describe these new approaches that plans offset specialty drug expenses. I then follow the dollar to show how they impact plan, patient, and manufacturer costs when compared with traditional approaches to copay support.

During the full 90-minute webinar, I discussed seven crucial risks that could disrupt this market along with many other aspects of this emerging market. If this clip whets your appetite for more, you can purchase the 90-minute webinar replay and full slide deck here: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here if you can’t see the video below.

Two recent Drug Channels article on these topics:

• Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support

• Employers Expand Use of Alternative Funding Programs—But Sustainability in Doubt as Loopholes Close

Errata: The formulary rebate in the mathematical example that begins at 4:40 should be shown as 16.7%, not 20%. We apologize for the error.

The Economics of Copay Accumulators, Maximizers, and Alternative Funding Programs (Video)

In my most recent video webinar, I explored how plans and PBMs are turning to novel—and highly controversial—benefit design tools that access manufacturers’ patient support spending: copay accumulators, maximizers, and alternative funding programs.

In the video excerpt below, I describe these new approaches that plans offset specialty drug expenses. I then follow the dollar to show how they impact plan, patient, and manufacturer costs when compared with traditional approaches to copay support.

During the full 90-minute webinar, I discussed seven crucial risks that could disrupt this market along with many other aspects of this emerging market. If this clip whets your appetite for more, you can purchase the 90-minute webinar replay and full slide deck here: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here if you can’t see the video below.

Two recent Drug Channels article on these topics:

• Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support

• Employers Expand Use of Alternative Funding Programs—But Sustainability in Doubt as Loopholes Close

Errata: The formulary rebate in the mathematical example that begins at 4:40 should be shown as 16.7%, not 20%. We apologize for the error.

The State of Employers’ Pharmacy Benefits: A Review of 2022 and the 2023 Outlook for Copay Programs (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from January 2023.

---

Now that 2023 is underway, let’s review employer-sponsored coverage for prescription drugs and speculate on what’s ahead.

Below I examine the latest data on pharmacy benefits: cost sharing tier structures, copayment vs. coinsurance, and out-of-pocket obligations. As you will see, pharmacy benefit designs again increased the use of coinsurance for specialty and fourth-tier drugs.

These designs significantly raise patients’ out-of-pocket obligations—and contribute to the controversy over copay accumulator adjustment and copay maximizers. In 2023, employers’ savings and PBMs’ profits from these programs will decline—which will trigger a coming crackdown on specialty drug benefits. Beneficiary beware!

P.S. As usual, you will also enjoy some terrible Drug Channels tiers/tears puns.

Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support (rerun)

I want to wish everyone a happy Juneteenth! This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from February 2023.

---

Is the gold rush in copay accumulators and maximizers slowing down?

Our latest update finds that for 2022, about 40% of commercial lives have adopted these benefit designs. Accumulator adoption has plateaued, while maximizer use has overtaken accumulators. Patients who take a single-source, brand-name specialty drug for autoimmune conditions, multiple sclerosis, and oncology increasingly face these benefit designs. Check out the plan and patient data below.

Patients are caught in the middle of a complex battle among insurers, PBMs, and drugmakers. They are rightfully unhappy that their plans are grabbing the copay support funds. That’s why legislation, lawsuits, and patient advocacy are growing. Manufacturers are also pushing back on plans’ copay games.

These reactions will slow the financial windfall for plans and PBMs—and raise the risk that plans will push the ethical boundaries even farther.

PBMs and the Battle Over Patient Support Funds:Accumulators, Maximizers, and Alternative Funding (NEW Live Video Webinar)

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for a new video webinar:

PBMs and the Battle Over Patient Support Funds:
Accumulators, Maximizers, and Alternative Funding
This event will be broadcast live on
Friday, June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET.

This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2023 Video Webinar Series.

WHAT YOU WILL LEARN

As expensive specialty therapies come to dominate drug spending, pharmaceutical manufacturers are paying a growing share of patents’ out-of-pocket costs for these prescriptions. At the same time, plans and PBMs are turning to novel—and often controversial—benefit design tools that access manufacturers’ patient support spending.

Join Dr. Fein as he helps you and your team deepen your understanding of this complex subject and its crucial implications for drugmakers, payers, PBMs, and patients. During the event, Dr. Fein will cover a wide range of topics, including:

• What’s driving patients’ out-of-pocket obligations

• Trends in the value of manufacturers’ financial assistance

• Copayment offset programs vs. patient assistance programs (PAPs)

• Conventional pharmacy benefit management tactics

• The new tools that offset specialty drug costs: copay accumulators, maximizers, and alternative funding programs

• The latest market data on adoption of the new spending drug management tools

• Prescription economics of copay accumulators, maximizers, and alternative funding programs

• How PBMs profit from—and are challenged by—the new tools

• Plan sponsor perspectives

• State and federal legislation over pharmacy benefits

• Major lawsuits between manufacturers and vendors

• Outlook for specialty drug spending management

• Controversies and unresolved questions

• And more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. He will draw from exclusive information found in DCI's 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Read on for full details on pricing and registration.

PRICING OPTIONS

You can register for this unique educational opportunity for only $380 per viewing device. Within 24 hours of your purchase, you will receive an email from Zoom with a unique link to access the live event.

We are offering substantial discounts for multiple registrations from the same organization. We know that many of you may be working remotely, so rates for multiple registrations are as low as $265 per device—a 30% savings. An unlimited number of people may watch at one physical location if they can watch from a single device. Please note that a device at a single physical location may not stream, share, or project our webinar to other sites. Each device at a physical location requires its own registration.

Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)

PBMs and the Battle Over Patient Support Funds:
Accumulators, Maximizers, and Alternative Funding

Please contact Paula Fein (paula@drugchannels.net) if you have any questions. If you purchase access for multiple devices, we will contact you for a list of your participants and their email addresses. Or, download this spreadsheet and email your registrants’ information to Tamra Feldman (admin@drugchannels.net).

Click here to register for the full Drug Channels 2023 Video Webinar Series

Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to email us if you would like to pay by corporate purchase order or check.

IMPORTANT THINGS TO KNOW

• Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.

• We use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.

• Within one day of purchasing a registration, each registrant will receive an email from Zoom with a link to access the event and add it to their calendar. Every registrant will also receive reminder emails from Zoom one week, one day, and one hour before the event.

• This event is part of The Drug Channels 2023 Video Webinar Series. If you have already purchased the full series, then you should have received an email from no-reply@zoom.us with your unique link to access the June event.

• Purchase of the webinar series includes a replay video of Drug Channels’ March 31, 2023, webinar Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Within 24 hours of purchasing the 2023 series, you will receive an email from Zoom with a link to access that video replay.

• Organizations that purchased corporate access for The Drug Channels 2023 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.

• Unfortunately, we are unable to offer refunds.

Employers Expand Use of Alternative Funding Programs—But Sustainability in Doubt as Loopholes Close

Last August, I warned you about alternative funding programs (AFPs)–the shady schemes by which commercial plan sponsors drop drug coverage in order to grab charity support intended for uninsured and indigent patients.

I’m sad to report that the manipulation of charitable patient assistance programs continues to expand. As you will see below, employers have significantly ramped up their adoption of AFPs, while health plans seem more skeptical. Meanwhile, a new AbbVie lawsuit sheds light on the alleged activities of a major AFP vendor.

Read on for our update on these suspect programs—and the growing risks to their sustainability. Caveat payer.

Drug Channels News Roundup, April 2023: OptumRx’s Biosimilar Nonsense, Accumulator Inequity, Amazon Redux, AFPs, and My Meeting with Mark Cuban

Baseball season is here! While we wait for the Phillies turnaround, let’s oil up our gloves, lace up our cleats, and run the bases around this month's biggest hits:

• Foul ball: OptumRx prefers higher prices for the first Humira biosimilar (SEE UPDATE BELOW)

• Strikeout: Copay accumulators hurt health equity

• Bench warmer: Surprise? Amazon has still not disrupted healthcare

• Spitting mad: Shady alternative funding programs (AFPs) face more scrutiny

Plus, I sit down with Mark Cuban—and take a selfie.

P.S. Join my nearly 41,000 (!) LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,000 followers. (I recommend that you follow me on LinkedIn, because the quality of comments is much, much higher than they are on Twitter.)

Drug Channels News Roundup, March 2023: My $0.02 on Insulin Price Cuts, AbbVie vs. AFPs, Optum Expands, ASAP340B, and Hooray for Pharmacists

Spring is here in sunny downtown Philadelphia, worldwide headquarters of Drug Channels. The vernal equinox has brought us an unexpected bounty of noteworthy news:

• Thoughts on the recent insulin price cuts by Lilly, Novo, and Sanofi

• AbbVie gets tougher on alternative funding programs

• Optum quietly adds a new drug channel role

• A novel partnership emerges to modernize the 340B program

Plus, a celebration of pharmacists’ activities during the COVID-19 pandemic.

P.S. Join my more than 38,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,000 followers.

Join me for my new live video webinar, Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook, on March 31, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook (NEW Live Video Webinar)

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for a new video webinar:

Discount Cards, Cost-Plus Pharmacies, and PBMs:
Trends, Controversies, and Outlook
This event will be broadcast live on Friday, March 31, 2023,
from 12:00 p.m. to 1:30 p.m. ET.

This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2023 Video Webinar Series. Anyone who registered for the entire series will receive an email with a link to access the March event.

WHAT YOU WILL LEARN

The rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market. Join Dr. Fein as he helps you and your team deepen their understanding of this important issue and its crucial implications. He will draw from exclusive information found in DCI's new 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

During the event, Dr. Fein will cover a wide range of topics, including:

• What’s driving the boom in patient-paid prescriptions

• The warped economics of the generic prescription channel

• Cash-pay prescriptions vs. discount cards

• Why Usual & Customary (U&C) prices matter

• The latest market data on the discount card market and its key participants

• The complex economics of discount cards

• How PBMs profit from—and are challenged by—patient-paid prescriptions

• Pharmacy strategies and reactions

• Why and how plans are placing discount cards within pharmacy benefits

• Commentary on GoodRx, Mark Cuban Cost-Plus Drug Company, and more

• Outlook for disruption of the pharmacy benefit market

• Controversies and unresolved questions

• And more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.

Read on for full details on pricing and registration.

PRICING OPTIONS

You can register for this unique educational opportunity for only $380 per viewing device. Within 24 hours of your purchase, you will receive an email from Zoom with a unique link to access the webinar replay video.

We are offering substantial discounts for multiple registrations from the same organization. We know that many of you may still be working from home, so rates for multiple registrations are as low as $265 per device—a 30% savings. An unlimited number of people may watch at one location if they can watch from a single device.

Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)

Discount Cards, Cost-Plus Pharmacies, and PBMs:
Trends, Controversies, and Outlook

Please contact Paula Fein (paula@drugchannels.net) if you have any questions. If you purchase access for multiple devices, we will contact you for a list of your participants and their email addresses. Or, download this spreadsheet and email your registrants’ information to Tamra Feldman (admin@drugchannels.net).

Click here to register for the full Drug Channels 2023 Video Webinar Series

Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to email us if you would like to pay by corporate purchase order or check.

IMPORTANT THINGS TO KNOW

• Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.

• We use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.

• Prior to the event, every registrant will receive an email from Zoom with a link to access the event and add it to their calendar. Every registrant will also receive reminder emails from Zoom one week, one day, and one hour before the event.

• This event is part of The Drug Channels 2023 Video Webinar Series. If you have already purchased the full series, you should have received an email from no-reply@zoom.us with your unique link to access the event.

• Organizations that purchased corporate access for The Drug Channels 2023 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.

• Unfortunately, we are unable to offer refunds.

Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support

Is the gold rush in copay accumulators and maximizers slowing down?

Our latest update finds that for 2022, about 40% of commercial lives have adopted these benefit designs. Accumulator adoption has plateaued, while maximizer use has overtaken accumulators. Patients who take a single-source, brand-name specialty drug for autoimmune conditions, multiple sclerosis, and oncology increasingly face these benefit designs. Check out the plan and patient data below.

Patients are caught in the middle of a complex battle among insurers, PBMs, and drugmakers. They are rightfully unhappy that their plans are grabbing the copay support funds. That’s why legislation, lawsuits, and patient advocacy are growing. Manufacturers are also pushing back on plans’ copay games.

These reactions will slow the financial windfall for plans and PBMs—and raise the risk that plans will push the ethical boundaries even farther.

The State of Employers’ Pharmacy Benefits: A Review of 2022 and the 2023 Outlook for Copay Programs

Now that 2023 is underway, let’s review employer-sponsored coverage for prescription drugs and speculate on what’s ahead.

Below I examine the latest data on pharmacy benefits: cost sharing tier structures, copayment vs. coinsurance, and out-of-pocket obligations. As you will see, pharmacy benefit designs again increased the use of coinsurance for specialty and fourth-tier drugs.

These designs significantly raise patients’ out-of-pocket obligations—and contribute to the controversy over copay accumulator adjustment and copay maximizers. In 2023, employers’ savings and PBMs’ profits from these programs will decline—which will trigger a coming crackdown on specialty drug benefits. Beneficiary beware!

P.S. As usual, you will also enjoy some terrible Drug Channels tiers/tears puns.

The Shady Business of Specialty Carve-Outs, a.k.a., Alternative Funding Programs (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: Drug Channels Outlook 2023.

In the four months since I published the article below, the issues with alternative funding programs have hit the mainstream press. Check out last week's article from Kaiser Health News: Employers Use Patient Assistance Programs to Offset Their Own Costs.

Click here to see the original post and comments from August 2022.

---

Watch out! Plan sponsors are getting even bolder in their attempts to grab financial support intended for patients. The latest scam is called a specialty carve-out.

Here’s the game: A commercial plan eliminates coverage for all specialty drugs. Beneficiaries are then shunted over to a charitable foundation, because they are now disguised as uninsured—at least for specialty drugs. Naturally, the vendor skims a healthy share of the charity’s money.

In addition to the ethical and compliance issues, some vendors raise safety risks by sourcing prescriptions from non-U.S. pharmacies as a backup.

The Orwellian euphemism for this “benefit” design: alternative funding program.

A new survey reveals that an astounding four out of 10 commercial plans are already using, or exploring the use of, these specialty carve-out programs. Yikes.

Read on for an overview of these shady programs—and the many problems they are creating.

Drug Channels News Roundup, September 2022: Patients vs. SaveonSP, PBMs’ Oncology Exclusions, Medicare Advantage Winners, HRSA’s 340B Reveal, and New DCI Offerings

Autumn is here! Please savor these Drug Channels acorns that we’ve squirrelled away for you:

• One patient’s troubling experience with SaveonSP

• PBMs ramp up formulary exclusions for oncology drugs

• The mega-players dominating Medicare Advantage

• My 340B FOIA efforts yield change at HRSA!

Plus, two new resources from Drug Channels Institute.

P.S. Join my 32,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,200 followers.

The Shady Business of Specialty Carve-Outs, a.k.a., Alternative Funding Programs

Watch out! Plan sponsors are getting even bolder in their attempts to grab financial support intended for patients. The latest scam is called a specialty carve-out.

Here’s the game: A commercial plan eliminates coverage for all specialty drugs. Beneficiaries are then shunted over to a charitable foundation, because they are now disguised as uninsured—at least for specialty drugs. Naturally, the vendor skims a healthy share of the charity’s money.

In addition to the ethical and compliance issues, some vendors raise safety risks by sourcing prescriptions from non-U.S. pharmacies as a backup.

The Orwellian euphemism for this “benefit” design: alternative funding program.

A new survey reveals that an astounding four out of 10 commercial plans are already using, or exploring the use of, these specialty carve-out programs. Yikes.

Read on for an overview of these shady programs—and the many problems they are creating.

How Copay Accumulators and Maximizers Have Changed Payers’ View of Copay Support

The boom in copay accumulators and maximizers has radically shifted payers’ views on manufacturers’ copay support programs for specialty drugs.

Below, I review a new survey of commercial plan sponsors and contrast the findings to a comparable survey from 2018. As you will see, plan sponsors now perceive manufacturers’ copay support patient assistance programs primarily as a source of funding for their own plans. This change in perspective has overtaken plan sponsors’ traditional views that copay programs disrupt formularies.

The accumulator/maximizer boom may soon start to slow. States are banning accumulators, the Medicaid accumulator rule has been blocked, and manufacturers are altering their copay programs. Plan sponsors may want to reconsider their beliefs before getting too comfortable with their copay money grab.

Four Reasons Why PBMs Gain As Maximizers Overtake Copay Accumulators (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from February 2022.

---

More than four years ago, I warned about the emerging trend of copay accumulators and outlined the costly consequences for patients.

The latest data reveal that copay accumulator adjustment programs are now in the word list for a growing share of pharmacy benefit designs. What’s more, adoption of copay maximizers now exceeds that of copay accumulators. Maximizers avoid the brutal patient adherence problems of accumulators, while allowing plan sponsors to extract even more patient support funds.

Despite this impressive growth, you may not yet have considered PBMs’ business model for these tools. Below, I outline why PBMs have incentives to prefer maximizer programs over accumulators and alternatives such as specialty carve-out programs.

I look forward to hearing your thoughts on these developments in the comments below or on social media: LinkedIn (preferred) or Twitter.

Four Reasons Why PBMs Gain As Maximizers Overtake Copay Accumulators

More than four years ago, I warned about the emerging trend of copay accumulators and outlined the costly consequences for patients.

The latest data reveal that copay accumulator adjustment programs are now in the word list for a growing share of pharmacy benefit designs. What’s more, adoption of copay maximizers now exceeds that of copay accumulators. Maximizers avoid the brutal patient adherence problems of accumulators, while allowing plan sponsors to extract even more patient support funds.

Despite this impressive growth, you may not yet have considered PBMs’ business model for these tools. Below, I outline why PBMs have incentives to prefer maximizer programs over accumulators and alternatives such as specialty carve-out programs.

I look forward to hearing your thoughts on these developments in the comments below or on social media: LinkedIn (preferred) or Twitter.