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2018-12-21 CSRO on Accumulator Adjustment Programs

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CSRO Talks Accumulator Adjustment Programs at CBI Summit

Posted: December 21, 2018


Accumulator Adjustment Programs have become an increasingly prevalent issue since CSRO was first made aware of them in late 2017. Since then, the programs have been progressively crossing over from the employer to commercial space.

Accumulator Adjustment Programs, also known as “out-of-pocket protection” or “coupon adjustment” programs, are a new utilization management tool being used by insurers and pharmacy benefit managers. These alternative cost-sharing structures prevent the value of co-pay assistance from being applied towards a patient’s deductible as an out-of-pocket expense. In the past, once the value of a patient’s co-pay assistance was depleted, a patients’ deductible had been met, ensuring they could afford otherwise financially inaccessible drugs.

Due to the move towards high deductible health plans, and the inherent costliness of the drugs used to treat complex chronic conditions, most patients will not be able to afford their medication once the co-pay card benefit is exhausted, and they are forced to start paying off untenable deductible amounts. This will result in otherwise stable patients discontinuing their treatments, allowing for irreversible disease progression, flares, loss of effectiveness for their original therapy, and other adverse effects.

Most recently CSRO’s President, Dr. Madelaine Feldman, presented at the CBI Copay Accumulator Summit in Philadelphia. Her presentation focused on how stakeholders can address patient adherence concerns resulting from accumulator programs. Dr. Feldman’s presentation to the conference provides an extremely comprehensive overview of the current landscape for accumulator programs and potential solutions that stakeholders can examine. One of the particular difficulties identified by Dr. Feldman was the many different names for these programs. Some plans refer to the program as an “Out-of-Pocket Protection Program,” others by “Coupon Adjustment Programs,” and some refer to them as something else entirely. This makes it difficult for patients to know whether they are subject to an accumulator program. Selecting coverage for these patients becomes a minefield that potentially exposes them to surprise bills.

Dr. Feldman stressed that it was important for physicians to speak with their patients about this emergent access issue that could impact their adherence so that they can make decisions that ensure they continue receiving the highest quality care possible. Among other methods, Dr. Feldman recommended posting information about the programs on waiting room television monitors, making handouts available to patients, or directing them to CSRO’s website. If you would like assistance putting together information to disseminate to your patients on accumulator adjustment programs, please contact CSRO at info@csro.info. You can also find out more information on the CSRO website.

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