Dr Bruce Sherman: Why Co-pay Accumulator Programs Are an Unlikely Fit for High-Cost Therapies

February 25, 2020

Co-pay accumulator adjustment programs will probably not be used for high-cost therapies because deductible amounts are trivial compared with their price tags and because these novel treatments are used for small populations, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Co-pay accumulator adjustment programs will probably not be used for high-cost therapies because deductible amounts are trivial compared with their price tags and because these novel treatments are used for small populations, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.

Transcript

As more novel, life-saving therapies with high price tags come to market, what impact will we see on the access and use of these therapies with co-pay accumulator adjustment programs in place?

I think we have to be mindful of the cost of those products in the context of the potential savings from the co-pay accumulator adjustment programs, because the deductible for an individual, even if that deductible were to be entirely accounted for by the cost of the medication, is trivial relative to the acquisition cost of the drug. So that together with the fact that these more expensive therapies are going to be likely provided to a much smaller population in a covered context of health plan enrollment, my sense is those co-pay accumulator adjustment programs probably will not be used in that setting.