Co-pay accumulator adjustment programs can have different effects for individuals with varying health plan types or income levels, explained Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Co-pay accumulator adjustment programs can have different effects for individuals with varying health plan types or income levels, explained Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Transcript
How might co-pay accumulator adjustment programs disproportionately affect certain populations?
From an insurance standpoint, the co-pay accumulator programs really are only in effect for individuals enrolled in a high-deductible, consumer-directed health plan. So, individuals who are in PPO [preferred provider organization] plans typically don’t have the high deductible with the pharmacy benefit that individuals have who are enrolled in a high-deductible health plan, where typically the deductible is a combined medical and pharmacy benefit.
That’s one consideration; the other concern is income, and the fact that there’s some evidence to suggest that low-income individuals, who are more price-sensitive to access to and use of healthcare, might preferentially select a high-deductible health plan simply because it provides them with more money in their pocket because of lower premiums, but at the expense of a high deductible. And they are probably the ones who would be at greatest risk of discontinuation of medication when faced with this so-called “co-pay surprise” when they’ve maximized the value derived from their co-pay support but haven’t yet met their deductible because of the co-pay accumulator adjustment program.
Dr Dalia Rotstein: Physicians Must Be Aware MS Affects People of All Backgrounds
April 24th 2024Dalia Rotstein, MD, MPH, emphazises the importance of awareness that multiple sclerosis (MS) impacts patients from various backgrounds as clinicians think through ways to improve access to care and research efforts in MS.
Read More
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Commonwealth Fund Report Details Pervasive Racial and Ethnic Disparities in US Health Care, Outcomes
April 18th 2024Using 25 health system performance indicators, the Commonwealth Fund 2024 State Health Disparities Report evaluated racial and ethnic disparities in health care and health outcomes both within and across US states and highlighted the urgent need for equitable health care policies and practices in the US.
Read More
Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
April 16th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode, in which we learn all about Freedom House 2.0 and the Pathways to Work program.
Listen
Dr Michael Farwell on FDG PET/CT Imaging to Predict Immunotherapy Response in Advanced Melanoma
April 15th 2024Michael Farwell, MD, associate professor of radiology at the Hospital of the University of Pennsylvania, provides insights into a study on the benefits of using 18F-fluorodeoxyglucose (FDG) PET/CT imaging to detect metabolic tumor changes in skin cancer.
Read More