Co-pay Accumulator Rule Could Cost Patients at the Pharmacy Counter

If patients are not informed about the implications of co-pay accumulator adjustment programs, they may be forced to abandon their prescriptions in the face of unaffordable co-pays, according to an interview with the author of a Commentary appearing in The American Journal of Managed Care.

Co-pay accumulator adjustment programs, or CAAPs, can help incentivize use of lower-cost generics by excluding drug manufacturer assistance from counting toward a patient’s out-of-pocket maximum. However, a rule finalized by HHS last year allows CAAPs to be applied even when no generic alternative is available. If patients are not informed about the implications of these programs, they may be forced to abandon their prescriptions in the face of unaffordable co-pays.

On this episode of Managed Care Cast, we’re talking with an author of a Commentary published in our August 2021 issue. The article, “CAAP Rule and Prescription Drug Prices,” explains the mechanisms of CAAPs and the potential consequences of the new HHS rule. Joining us is Bryan S. Walsh, JD, of Brigham and Women’s Hospital and Harvard Medical School.

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