Many patients find relief from the costs of medication through copay assistance or rebate programs. Copay assistance is real money that is disbursed through need-based programs run by charitable organizations or drug manufacturers, to help qualifying patients cover the costs of their medication, reducing patients’ out-of-pocket costs.
However, with copay accumulator policies in place, health plans and Pharmacy Benefit Managers (PBMs) collect the patient’s payment but don’t count it towards the patient’s annual deductible or out-of-pocket maximum.
The effect of copay accumulator policies is that patients in financial need can’t reduce their out-of-pocket costs which then leads to non-adherence, followed by worse health outcomes, increased inequities, and higher overall health care costs.