Everything to know about copay accumulators, copay maximizers, and alternative funding programs

JMCP article provides in-depth review of cost-shifting strategies currently in play with commercial insurers.

Aptly placed under the “Primer” section of the August issue of the Journal of Managed Care + Specialty Pharmacy (JMCP)―the official peer-reviewed journal of the Academy of Managed Care Pharmacy―2024;30(8):883-96, the authors provide a comprehensive review of cost-shifting strategies among commercial insurers in response to manufacturers’ establishment of copay support and patient assistance programs, primarily in the area of specialty medications.

Using a single example patient case throughout—J.W., a 34-year-old with a history of moderate to severe Chron’s disease—the authors walk through each scenario on how J.W. would get his drugs, what would happen with the insurance in regard to the type of program in place, as well as the patient perspective. The costs section of each are chockful of graphics and tables as well as comparisons. These scenarios include copay adjustment programs, copay accumulator programs, copay maximizer programs, and alternative funding programs.

The final section of the paper offers insights for care teams on navigating these various programs.

The authors also offer definitions at the end, which was adapted from the AMCP Managed Care Glossary.

Editor’s Note: If you are new to cost-shifting programs or if you like handy guides on hand, then this is a go to.

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