Implications for Brand Leaders

The biggest implication of copay accumulators and maximizers for manufacturers are increased copay card program costs.


Due to these programs, manufacturers may soon realize a sharp increase in their copay card program costs, which will impact brands’ financial performance.


Additionally, patients will be surprised and frustrated by higher-than-expected cost-shares, causing them to abandon scripts, skip doses or switch medications.


Ultimately, patients will likely lash out at whoever they perceive as the cause of this problem, which may be the manufacturer, payer or both.

Brand leaders can take steps to reduce exposure to copay accumulators and maximizers and identify alternative approaches to copay card programs

Step 1: Assess Your Risk

Before rushing to act, manufacturers concerned about their copay card programs should better understand their exposure to these new payer tactics.


Through claims data and payer surveys, manufacturers can accurately assess the breadth and depth of risk to their copay card programs. Importantly, the risk will vary over time as adoption of these payer tactics evolves.


Furthermore, copay maximizers will not affect all manufacturers since they are typically limited to select disease areas.


Additionally, manufacturers should assess the risk to each active copay card program.


Programs with a high maximum benefit are most at risk.


Consider a diabetes drug with a monthly list price of $500 and a copay card that will reduce a patient’s cost-share to $10 with a maximum benefit of $400 per month.


Under a copay accumulator program, a patient could spend the entire year in the deductible phase, forcing the manufacturer to cover nearly the entire cost of the drug.

Step 2: Identify the Right Tactics

Tactic: Alter copay card terms to limit exposure


For the above diabetes drug example, the manufacturer could cut the maximum discount from $400 to $100 to significantly decrease their copay accumulator risk.


While helpful to the manufacturer, this option alone will not address patient affordability challenges.


Tactic: Explore new and innovative ways to provide financial assistance to patients


One option could be a patient rebate program to circumvent a copay accumulator or maximizer.


In this program, the patient would submit claims to the manufacturer after filling their prescription. Program terms could mirror the original copay card program.


Since the manufacturer’s assistance is not provided at the point of sale, copay accumulators or maximizers would not apply.


While not without challenges, creative solutions, like a rebate program, can allow a manufacturer to continue their commitment to drug affordability.


Of course, collaboration with legal and compliance partners is critical to ensure sound programs.


Tactic: Re-evaluate contracting strategy


While likely more expensive than the original copay card program, strategically selecting payers to contract with may be the right choice for some manufacturers and brands.


Clearly, copay accumulators and maximizers create new challenges for brand leaders.


However, with proactive effort and help from the right partner, solutions can be developed to continue to allow manufacturers to make their drugs affordable for patients.


At Herspiegel Consulting, we bring expertise to our clients from strategy through execution across the commercial space.


Please feel free to contact us using the form below to discuss how we can assess your copay card program’s risk from copay accumulators and maximizers.