The Battle Over Copay Assistance - Health Strategies Group

The Battle Over Copay Assistance - Health Strategies Group

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 UHCs integrated commercial business (~9 million lives)
and excludes its OptumRx direct commercial business.

$13 billion
in prescription
volume

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.

$35 billion
in prescription
volume

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.

$27 billion
in prescription
volume

Primes 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
dont apply to members maximum OOP accumulators.
Copay Accumulator Programs
Focus on Specialty Pharmacy

$16 billion
in prescription
volume

Source: Health Strategies Group, Insurance and Benefit Design, April 2018.
2018 Health Strategies Group. All rights reserved.

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