Co-pay Accumulator Programs: Impact and Challenges

STUDY OVERVIEW

Payers and Pharmacy Benefit Managers (PBMs) have turned to co-pay accumulators - and other like-minded programs with different names - to counter rising pharmaceutical costs. Payers are using these programs to block traditional forms of manufacturer-sponsored financial assistance for therapies, such as co-pay coupons. The result has been patients paying more out-of-pockets costs, and switching to generics or other lower cost therapies.

Best Practices®, LLC conducted this study to highlight the impact of payer-imposed “co-pay accumulator” programs (CAs) on specialty manufacturers and their patients. The study will help market access leaders better understand the threat, impact and challenges that co-pay accumulator programs present to the pharmaceutical industry and patients.

Topics addressed in this study include:

• Copay accumulator threat assessment
• Key market triggers and decision points considered for counteracting copay accumulator threats
• Future market access challenges and potential mitigation tactics

• Quantifying the Co-pay Accumulator Threat
• Key Indicators of Co-pay Accumulator Impact on Specialty Products
• Future Threats and Market Access Challenges

• Characterizing the severity of the threat posed by copay accumulator programs (and related programs like copay maximizers) to benchmarked organizations and the pharmaceutical manufacturing industry on the whole
• Success rating of benchmarked companies’ copay accumulator mitigation strategy thus far
• Leading and lagging indicators of copay accumulators
• Average percentage of specialty products currently affected by copay accumulators
• Approximate percentage of total commercial channel product volume subjected to co-pay accumulator programs
• Market access leaders’ approach toward altering their copay accumulator mitigation strategies as legislative developments come into effect from Jan. 1, 2020
• Leading indicators of copay accumulator impact and trigger for taking action
• Lagging indicators of accumulator-driven brand erosion
• Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – Total benchmark class
• Importance of listed factors in convincing organizational leadership of the need to take action to counteract copay accumulators – OOPC minimizers and Manufacturers with no OOPC progress
• Voices from the field: Single-most critical factor for implementing copay accumulator mitigation strategy
• Characterizing the threat posed by copay accumulator programs to the individual pharma organization and the pharmaceutical industry on the whole
• Likelihood of new payer / PBM payment policies circumventing pharma manufacturer’s copay accumulator mitigation strategy
• Interview narrative around payer negotiations
• Optimal path for resolving copay accumulator issues
• New payer strategies and tactics, besides copay accumulator mitigation activities, likely to negatively impact patients / manufacturers; potential mitigation tactics for these new payer strategies
  

• Among companies that track leading indicators, up to 94% have measured increases in out-of-pocket-costs (OOPC), number of patients impacted, field complaints, patient complaints and abandonment rate. Most manufacturers have seen 1-10% increases in OOP, abandonment and complaints. One-fifth of respondents have measured OOP growth in the 11-30% range.

Best Practices, LLC engaged 25 Market Access and Patient Support executives from 21 specialty biopharma companies. This research includes, quantitative data from 25 survey responses and qualitative insights from 9 deep-dive interviews.

If you purchase Best Practice Database document(s), you will have 30 days from the date of purchase to apply some or all of the cost of the document(s) toward the cost of a Full Access Individual, Pharma, Group or University Membership. Write us at DatabaseTeam@bestpracticesllc.com or call David Guinn at 919-767-9179 if you have any questions.