Other commonly affected specialty therapeutic areas are multiple sclerosis and oncology. For instance, in 2022, 14 percent of autoimmune patients taking brand-name drugs had an accumulator or maximizer adjustment applied to their benefit. These programs impact patients taking specialty drugs the most since those products have the highest out-of-pocket costs and most well-funded out-of-pocket support programs. That’s a significant jump from 2018, when those figures were 44 percent and 14 percent, respectively. Last year, 89 percent of commercially insured beneficiaries were enrolled in plans with accumulators available in the plan design and 76 percent were enrolled in plans with maximizers in the plan design, per Drug Channel. Maximizer programs also don’t allow manufacturer support payments to count toward your annual deductible and out-of-pocket obligations. Maximizer programs set patients’ out-of-pocket maximums equal to the maximum value of a manufacturer’s patient-assistant program, which is usually spread evenly throughout the benefit year. The next iteration has been the maximizer program, which is a little different, but the same principle applies - that any type of patient assistance that comes from the pharmaceutical industry would not count toward a patient’s deductible or maximum out-of-pocket cost.” “But it’s not just about the accumulators. “It started about five years ago when the pharmacy benefit management companies started introducing the accumulator program marketplace, so they convinced a lot of employers to pick it up as part of their benefit design,” says Robert Popovian, PharmD.Chief Science Policy Officer at GHLF. After that $6,000 is covered by the patient assistance program, you still have to pay $6,000 out-of-pocket since none of it was counted toward the deductible with an accumulator adjuster program, per the Global Healthy Living Foundation (GHLF). Accumulator programs don’t allow patient assistance through the pharmaceutical industry to count toward the deductible set by the insurance company.įor example, let’s say your patient assistance card has a $6,000 limit and your deductible is $6,000. However, the specific fine print in your insurance around programs called accumulators and maximizers may mean the difference between being able to afford your medication or not.Ī copay accumulator adjuster program is a type of health insurance program that affects people using biopharmaceutical patient assistance programs, which are usually provided by a drug manufacturer to help reduce the cost of taking the medication. As you’re likely far too familiar, insurance often gets complicated quickly.
0 Comments
Leave a Reply. |