Dr Bruce Sherman Describes Ways Employers Can Tweak Co-pay Accumulator Programs to Help Patients

February 19, 2020

SAP Partners

According to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions, there are several ways that employers can alleviate the impacts of co-pay accumulator adjustment programs on their employees, including by increasing awareness of the programs, expanding preventive drug lists, subsidizing benefits for low-income workers, and considering the true financial impact of these programs.

According to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions, there are several ways that employers can alleviate the impacts of co-pay accumulator adjustment programs on their employees, including by increasing awareness of the programs, expanding preventive drug lists, subsidizing benefits for low-income workers, and considering the true financial impact of these programs.

Transcript

Are there suggestions for how to adjust these co-pay accumulator adjustment programs to address some of the unintended consequences?

Sure, there are a number of ways that employers, plan sponsors can perhaps think differently about the use of the co-pay accumulator cards. And I think, first and foremost, one has to think about, what’s the goal that one is trying to achieve with the co-pay accumulator cards and is it really financially impactful for the employer. So that’s really the first issue, and our preliminary research would indicate that, based on modeling, this literally translates to about a penny per member per month in terms of additional cost for the employer if they allow those co-pay cards to be used without a co-pay accumulator program.

But in terms of modifying the co-pay accumulator adjustment programs, there are a number of factors that could be considered. One is foundationally, if an individual is on specialty drugs, they probably should be counseled or at least be made aware of the existence of the co-pay accumulator adjustment programs at the time of benefits enrollment so that they can choose perhaps to enroll in a PPO [preferred provider organization] plan or non—high-deductible health plan that would protect them to some degree from that unanticipated high payment when the co-pay support runs out. So that’s number 1 at the foundational level.

There are a number of modifications that could be implemented with respect to application of the co-pay accumulator adjustment programs, probably the most important is which medications are included in that co-pay accumulator adjustment program. Not all medications are; for example, in the study that we performed looking at this issue, medications for multiple sclerosis were on the preventive drug list and excluded from the eligibility for the co-pay accumulator adjustment program. So, employers have an opportunity to include more medications on that preventive drug list and be selective about which medications are subject to the co-pay accumulator program or not.

The other issue from an affordability standpoint is to ensure that individuals who are perhaps low-income workers may have an opportunity to have their benefit design subsidized to make the benefits more equitable for them, such that they can afford to pay the cost of the deductible should they choose that plan. That kind of subsidy support can be provided in the form of premium reductions for the plan design, [or] it can be in the form of wage-based deductible levels or wage-based employer contributions to the HSA [health savings account].