1. Copay Accumulator Programs Focus on Specialty Pharmacy
11/17/2018
Health Strategies Group
Author/Artist
Copay Accumulator Programs Focus on Specialty Pharmacy
Examples of Copay Accumulator Programs
Coupon Adjustment: Benefit Plan Protection Program
Implemented January 1, 2018, this program provides a real-time solution that counts only the amounts members have paid (i.e., does not include amounts paid by copay card programs) toward their deductibles and OOP maximums when filling at BriovaRx. This applies only to UHC’s integrated commercial business (~9 million lives) and excludes its OptumRx direct commercial business.
CVS Specialty Copay Card Program
The first component of this program, True Accumulation, sends an adjustment within 24 to 48 hours after the prescription is filled to remove any dollars the member did not actually pay toward the deductible and OOP maximum. This applies to all specialty drugs dispensed by CVS specialty.
Out-of-Pocket Protection Program
This program corrects the assistance accumulation, so that only the amounts members spend will be reflected in their deductibles and OOP maximums. Members may continue to receive specialty drug copay assistance from pharmaceutical manufacturers.
Prime’s Specialty Copay Solutions
This program uses specialty copay coupons to adjust copay amounts for select drugs. The coupons can still be used, but the amounts of the manufacturer coupons are adjusted so they
don’t apply to members’ maximum OOP accumulators.
$13 billion
in prescription volume
$35 billion in prescription volume
$27 billion in prescription volume
$16 billion in prescription volume
Copay Accumulator Programs Focus on Specialty Pharmacy
Source: Health Strategies Group, Insurance and Benefit Design, April 2018.