![]() ![]() PBMs typically offer accumulator solutions directly to their plan sponsor clients: But there is a crucial difference in how these programs are being implemented. See what you think.īoth accumulators and maximizers let payers extract the full value of the manufacturer’s copay support. Here’s what I managed to uncover about these businesses. Why do multi-billion-dollar public companies rely on these private companies to administer their maximizer programs? Why do these small companies deserve such outrageous fees? Why are beneficiaries required to affirmatively sign up with the companies-or face ludicrous costs that far exceed their plan’s out-of-pocket maximums? Does any oversight exist for these arrangements? ![]() What’s more, at least one of these private companies earns fees equal to 25% of the manufacturer’s copay support program. The two largest PBMs-CVS Health’s Caremark and Cigna’s Express Scripts-have each partnered with secretive and independent private companies to operate specialty drug maximizer programs for their plan sponsor clients. However, maximizers are being implemented very differently from accumulators. I also highlighted why plans have responded to the negative patient impact from accumulators with copay maximizer programs. In Copay Maximizers Are Displacing Accumulators-But CMS Ignores How Payers Leverage Patient Support, I explained a new Centers for Medicare and Medicaid Services (CMS) final rule regarding health plans’ use of copay accumulator adjustment. ![]()
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