Copay Accumulator Update: Widespread Adoption As Manufacturers and Maximizers Limit Patient Impact

In January, I alerted you to an important new benefit design trend in Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit. It is by far the most widely read article ever published on Drug Channels. New data from Zitter Health insights (ZHI) suggest that these programs are widely used. Nearly one-third of commercially-insured lives are enrolled in plans that have implemented copay accumulator adjustment or closely-related copay maximizers. (We explain the benefit design math behind maximizers below.) ZHI also found that a surprising number of plans are already set up to use these programs, but have not done so … Continue reading Copay Accumulator Update: Widespread Adoption As Manufacturers and Maximizers Limit Patient Impact

The State of Specialty Pharmacy 2018: Reflections from #Asembia18 (rerun)

This week, I’m rerunning some popular posts before the Labor Day weekend. Click here to see the original post and comments from May 2018. Last week, Paula and I had the pleasure of attending Asembia’s 2018 Specialty Pharmacy Summit. The Specialty Pharmacy Summit remains the most important forum in the specialty marketplace. This year, a record 6,500 people learned, networked, and connected in Las Vegas. It was another year of record attendance. (Here’s the official press release.) Drug Channels again salutes Larry and Robert Irene for sustaining and growing an annual event that unites the entire industry. Today marks the … Continue reading The State of Specialty Pharmacy 2018: Reflections from #Asembia18 (rerun)

Hidden Policies: The Search for Copay Accumulator Policies in Florida Qualified Health Plans

Today’s guest post comes from Carl Schmid, Deputy Executive Director of the AIDS Institute. The AIDS Institute studied health plans in Florida and uncovered a troubling reality: Patients are often unable to find out if their plan has a copay accumulator adjustment program. Even when the information was somehow available, it was vague and ambiguous. The AIDS Institute’s research shows how unsuspecting patients can get stuck with exorbitant out-of-pocket expenses for specialty drugs that have no generic or therapeutic alternatives. That’s why I told CNBC this week that accumulators are “as much of a cash grab from patients as I can possibly … Continue reading Hidden Policies: The Search for Copay Accumulator Policies in Florida Qualified Health Plans

Drug Channels News Roundup, May 2018: CVS Caremark, Albertsons/Rite Aid, Copay Accumulators, and A World Without PBM Rebates

It’s almost June—wedding season! Our invitation to the recent royal nuptials apparently got lost in the mail, but I invite you to our own monthly shower of noteworthy news: More questions about CVS Caremark’s profits in Ohio’s managed Medicaid programs Albertsons and Rite Aid reveal new details about their pharmacy plans HIV service organizations warn of patient dangers from copay accumulators Plus, we revisit the classic Drug Channels black swan article for hints to a future without PBM rebates. P.S. @DrugChannels on Twitter is now approaching 6,000 followers. Throw some rice and enjoy my daily tweets of interesting news, stories, … Continue reading Drug Channels News Roundup, May 2018: CVS Caremark, Albertsons/Rite Aid, Copay Accumulators, and A World Without PBM Rebates

Reflections from #Asembia18: The State of Specialty Pharmacy 2018

Last week, Paula and I had the pleasure of attending Asembia’s 2018 Specialty Pharmacy Summit. The Specialty Pharmacy Summit remains the most important forum in the specialty marketplace. This year, a record 6,500 people learned, networked, and connected in Las Vegas. It was another year of record attendance. (Here’s the official press release.) Drug Channels again salutes Larry and Robert Irene for sustaining and growing an annual event that unites the entire industry. Today marks the eighth year that I will violate Vegas code and tell you what happened there. Below, I offer reflections on the meeting and highlight key … Continue reading Reflections from #Asembia18: The State of Specialty Pharmacy 2018

Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2018. Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs—a benefit design option that I expect to become highly controversial this year. Accumulator programs target specialty drugs for which a manufacturer provides copayment assistance. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum. As you will see below, plan sponsors—employers and health plans—will save big money because accumulators shift a majority of … Continue reading Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit (rerun)

Drug Channels News Roundup, April 2018: Copay Accumulators, Express Scripts, Pharmacy Pricing, Amazon, and Almost-Pharmacist Jack Nicklaus

Baseball season is finally here! Oil up your glove, lace up your cleats, and let’s run the bases around this month’s news stories. Remember: Sometimes you win, sometimes you lose, and sometimes it rains. In this issue: Green Monster: The drug manufacturers that are most vulnerable to copay accumulators Pop Fly: Express Scripts wants to pop the gross-to-net bubble? Foul! Fresh evidence that uninsured consumers pay rip-off cash prices at retail pharmacies Strikeout: My $0.02 on Amazon’s decision not to sell drugs to hospitals Plus, from the diamond to the green: the secret pharmacy history of golf legend Jack Nicklaus. … Continue reading Drug Channels News Roundup, April 2018: Copay Accumulators, Express Scripts, Pharmacy Pricing, Amazon, and Almost-Pharmacist Jack Nicklaus