Dr Bruce Sherman: Disproportionate Effects of Co-pay Accumulator Programs Across Populations

March 10, 2020

SAP Partners | <b>National Alliance of Healthcare Purchaser Coalitions</b>

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.