Copay Accumulator Programs & Pharma: What’s Next?
Michael Blom, Principal | Ross Wilkinson, Senior Manager | Gloria Siclari, Senior Associate | Luke Versten, Associate
A closer look at CAPs and how they might affect your brand
Dynamics between pharma and the market-based healthcare sector it serves have invariably been complex, with one of the biggest drivers of that complexity being effective management of patient demand and payer systems.
And over time, payer business models are becoming increasingly convoluted. The newest stratagem in this push and pull is the copay accumulator program, or CAP. First introduced in 2018, these programs are now rapidly being rolled out by payers, with data showing that nearly one-third of commercially insured patients are now directly impacted by CAPs – enrolled either in plans that have implemented copay accumulator adjustment or closely-related copay maximizers.
The CAP, with its differing and confusing scopes of application, is one more contour to successfully navigate when attempting to balance clinical and economic value in product development and commercialization decisions.
What is a CAP?
Copay accumulator programs (CAPs) permit employers and PBMs to exclude copay assistance from the calculation of a patient’s annual deductible, effectively negating the value of the copay assistance for said patient.
Prior to the introduction of the CAP, payers sought to guide patients toward less expensive treatments by making them pay a higher portion of a drug’s costs. Drug-makers responded by increasing the financial aid they offer, in the form of copay assistance, to shield consumers from these rising expenses. Payers, however, have now turned the tables on Pharma. They are using CAPs to leverage the value of the manufacturer copay coupon, in turn increasing beneficiary cost-sharing amounts to meet deductible amounts.
As the impact of COVID-19 pandemic continues to expand globally, pharmaceutical and biotech players are beginning to feel the disruptive effects of the outbreak. New clinical trials will be significantly delayed as companies continue to face challenges arising from COVID-19, from potential patient quarantines, to site closures, travel limitations or interruptions to the supply chain for new investigational products.
Deallus is excited to announce that Jenny Cummins will be partnering with Deallus as a Strategic Advisor. Jenny’s experience in formulating strategic direction within and outside of pharmaceutical companies is something we are excited to add to our panel of strategic advisors. Our clients will benefit from her expertise in the healthcare sector as well as her impressive leadership, communication, and facilitation skills.
We are excited to announce that Gloria Kwon has joined our Deallus team as a Senior Principal based out of our Los Angeles office. Gloria comes to Deallus with significant experience in business strategy, product commercialization and operational excellence for pharmaceutical and biotechnology companies. Prior to joining Deallus, Gloria spent over 8 years at Navigant Consulting.
Deallus is pleased to announce that Peter Barschdorff is joining the organization as Vice President, leading its U.S. consulting business, with offices in Los Angeles and New York. Peter has held leadership positions in a number of management consulting organizations and has built innovative enterprise capabilities in commercial pharma.