Rising Specialty Drug Costs and Co-Pay Models Raise Access Concerns: Patty Taddei-Allen, PharmD, MBA

Out-of-pocket costs for specialty drugs are increasing and, as a result, burden the consumer. At a session of the Academy of Managed Care Pharmacy (AMCP) annual meeting, experts discussed how pharmacy benefit managers use methods like co-pay accumulators, maximizers, and alternative funding programs to lessen costs for patients.

In an interview with The American Journal of Managed Care, Patty Taddei-Allen, PharmD, MBA, a clinical assistant professor at the University of Florida and a panelist during that AMCP session, highlighted gaps in access to care within some of the models.

“What we're seeing with some of these accumulator programs in particular is that patients may believe that they’ve met their deductible, or they have a lower cost share, and then suddenly, when that co-pay card runs out, perhaps mid-year, they suddenly have kind of a sticker shock,” Taddei-Allen said. “And when there's that sticker shock, sometimes they may not be able to afford the medication that month, [and we] start seeing some reductions in adherence.”

Taddei-Allen also referenced prior research focused on co-pay maximizers that maintain a steady small or nonexistent co-pay, but with it, patients may not be meeting their deductible.

As a result, she said, “They’re surprised by other nonpharmacy or non–prescription medication cost shares like imaging or other types of medical services.”

In addition to the models, Taddei-Allen also pointed out the overall shift in employer plan drug costs, shifting more of the responsibility to the patients in the form of higher deductibles, cost sharing for specialty drugs, and moving away from flat co-pays for specialty medications.

“And as a result of that, plans and PBMs [pharmacy benefit managers] are really looking to see how they can best manage and protect, from their perspective, the integrity of the plan's benefit design,” she said. “[To ensure] that those dollars a manufacturer may be putting towards a medication won't necessarily be going towards that patient's deductible for them to then meet their deductible or to meet their maximum out-of-pocket costs.”