Accumulator adjustment programs lead to surprise out-of-pocket costs and nonadherence, analysis finds

A new analysis by IQVIA looked at three cost-sharing assistance programs and found that from 2018 to 2020, 25% to 36% of patients discontinued treatment when they faced an unexpectedly high out-of-pocket cost of $1,500 or more in the middle of the plan year. These unexpected costs were caused by accumulator adjustment programs operated by pharmacy benefit managers and health plans.

Sharing rebates can improve access to medicines and increase health equity

Conversations and healthy debate about issues facing our industry and the health care system are critical to addressing some of today’s challenges and opportunities. The Catalyst welcomes guest contributors, including patients, stakeholders, innovators and others, to share their perspectives and point of view.

Today, we are pleased to welcome a guest post from Dr. Leah Zullig, an associate professor at the Duke School of Medicine in Population Health Sciences, who is dedicated developing, evaluating and implementing approaches to support patients with taking their medications.

Commercial health plans have increased patients’ out-of-pocket costs by over 50% in some therapeutic areas

According to a recent IQVIA analysis, commercial health plans have increased patients’ average out-of-pocket costs for brand medicines by over 50% in some therapeutic areas since 2015. Notably, of the seven therapeutic areas that IQVIA analyzed, including anticoagulants, asthma/COPD, depression, diabetes, HIV, multiple sclerosis and oncology treatments, average patient cost exposure between 2015 and 2019 saw a 32% increase for depression, a 50% increase for HIV and a 56% increase for anticoagulants. Cost exposure represents the level of cost sharing patients would have paid out of pocket if financial assistance, like manufacturer cost-sharing assistance, had not been available.