Seeing Accumulator Adjustment Programs Through Patients’ Eyes


Pharmacy Benefit Managers’ (PBMs) “accumulator adjustment programs” are leading to a new kind of access challenge for patients. In these programs, the dollars paid by a manufacturer sponsored copay program are NOT applied to the patient’s deductible requirements, so that after a patient has exhausted the copay program benefits there may still be a large portion of the patient’s insurance deductible remaining to be paid. In such a case, the patient’s insurance would cover none of the cost of the medication, leaving the patient responsible to pay the entire cost out of their own pocket until the deductible is met. [For more background on accumulator adjusters, see the ConnectiveRx white paper, “Copay accumulator adjustment programs: A new kind of sticker shock.”]

Adam Fein, PhD, CEO of Drug Channels Institute, believes accumulator adjustment programs may create “massive adherence problems” as ballooning out of pocket (OOP) costs threaten an increasing number of patients.1 This doomsday scenario, while worrisome for all patients impacted, would be especially distressing for those who are using complex biologics. These patients with serious chronic conditions are at particular risk of medication abandonment for many reasons, including affordability. Moreover, the system-wide impact of therapy drop off among these patients is potentially serious and costly due to the nature of their conditions. Despite these threats to patients and the healthcare system, one observer estimates that by the end of 2018, 50% of self-insured employer plans will be employing accumulator adjustment programs.2

In June 2018, ConnectiveRx surveyed patients to learn their opinions on accumulator adjusters.

Survey Background

In order to quantify patients’ perspectives on copay accumulator adjustment programs, the ConnectiveRx market research team conducted a survey of 503 patients (or their caregivers) who had chronic disease likely to be treated with specialty medication(s). The study had two primary objectives:

  1. Assess patient knowledge (unaided and aided) of “accumulator” insurance products
  2. Once the accumulator adjustment concept is explained, assess its potential impact:
    • On medication adherence
    • On patients’ perceptions of payers and sponsors (employers)

To participate, patients must have used a copay coupon at least once in the last 12 months. Chronic diseases targeted included cancer, Crohn’s disease, growth hormone disorder, hepatitis C, HIV, multiple sclerosis, psoriasis, pulmonary arterial hypertension and rheumatoid arthritis. These patients have substantially greater than average exposure to the health care system, and therefore would be expected to be among the most educated about the healthcare system and how to use it to manage their care.



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