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Citing Reduced Adherence to Recommended Treatment, ASCO Opposes Use of Copay Accumulators, Copay Maximizers for Patients with Cancer

Oncology Practice Insider

The American Society of Clinical Oncology (ASCO) issued a new position statement strongly opposing the use of copay accumulator programs and copay maximizer programs for individuals with cancer. The statement also makes recommendations to protect patients from the potential harms of such programs.

Copay accumulators and copay maximizers are payer-imposed utilization management practices. With either program in place, a drug manufacturer’s copay assistance (usually a drug coupon or card that a patient brings to their pharmacy to obtain a discount on their cost-sharing) no longer applies toward a patient’s deductible or out-of-pocket maximum. This means that patients’ out-of-pocket costs go up, and it takes them longer to reach required deductibles.

These programs could harm patients by reducing patient adherence to physician-prescribed treatment. A 2019 study found that health savings account patients under an accumulator adjustment program for specialty autoimmune drugs had significantly lower monthly prescription fill rates, higher risk of discontinuation, and lower proportion of days covered compared to patients enrolled in preferred provider organization plans. A cancer-specific study also found that higher prescription copays were associated with both non-persistence and non-adherence to prescribed treatment, particularly among older women. Read more.