The American Society of Clinical Oncology (ASCO) issued a new position statement strongly opposing the use of copay accumulator programs and copay maximizer programs for individuals with cancer. The statement also makes recommendations to protect patients from the potential harms of such programs.
Copay accumulators and copay maximizers are payer-imposed utilization management practices. With either program in place, a drug manufacturer’s copay assistance (usually a drug coupon or card that a patient brings to their pharmacy to obtain a discount on their cost-sharing) no longer applies toward a patient’s deductible or out-of-pocket maximum. This means that patients’ out-of-pocket costs go up, and it takes them longer to reach required deductibles.
These programs could harm patients by reducing patient adherence to physician-prescribed treatment. A 2019 study found that health savings account patients under an accumulator adjustment program for specialty autoimmune drugs had significantly lower monthly prescription fill rates, higher risk of discontinuation, and lower proportion of days covered compared to patients enrolled in preferred provider organization plans.1 A cancer-specific study also found that higher prescription copays were associated with both non-persistence and non-adherence to the prescribed treatment, particularly among older women.2
ASCO recommends the following to address the potential harms these programs may cause patients:
- The Centers for Medicare & Medicaid Services (CMS) should prohibit the use of copay accumulator adjustments and copay maximizers in the programs it administers and regulates.
- To further protect patients, federal and state governments should pass legislation that prohibits the use of copay accumulator adjustment and copay maximizer programs.
- Commercial insurers and pharmacy benefit managers (PBMs) should immediately discontinue the use of copay accumulator adjustment and copay maximizer programs.
- At a minimum, while copay accumulator adjustment programs remain in place, public and commercial insurers and PBMs should ensure transparency by clearly describing the program’s design for beneficiaries, as required by the CMS Summary of Benefits and Coverage Instruction Guide.
Read the full position statement.
1Sherman BW, Epstein AJ, Meissner B, Mittal M. Impact of a co-pay accumulator adjustment program on specialty drug adherence. Am J Manag Care. 2019 Jul;25(7):335-340. PMID: 31318506.
2Neugut AI, Subar M, Wilde ET, et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol. 2011;29(18):2534-2542. doi:10.1200/JCO.2010.33.3179