Accumulators, Maximizers Exacerbate Healthcare Disparities, Says Janssen Research | AMCP Nexus 2022

Research by Janssen shows that non-White patients are disproportionately affected by the accumulators and maximizers that PBMs use to blunt the financial consequences of copay assistance cards.

A new front may have opened in the war that pharmaceutical manufacturers and pharmacy benefit managers (PBMs) have been waging over copay accumulators and maximizers: healthcare disparities.

In a findings presented in a poster at AMCP Nexus 2022, Janssen researchers found that non-White patients were disproportionately affected by PBM copay accumulator and maximizer programs.

The researchers , led by Mike Ingham, a Janssen Scientific Affairs employee, found that non-White patients were 31% more likely to be affected an accumulator program and 27% more likely by a maximizer.

“Benefit plans imposing CAPs (copay adjustment programs) pose a disproportionate burden on historically marginalized populations and people of color, further exacerbating existing health disparities,” is one of the conclusions on the poster

Ingham and his colleagues acknowledged in the limitations section of the poster that confounders such as disease severity and comorbidities were not factored into their results.

Accumulator and maximizers are programs that PBMs have started to combat the financial consequences of the copay assistance programs that most drug manufacturers offer. The assistance programs undercut their formularies and create demand for high-priced drugs by shielding patients from copays and coinsurance, argue the PBMs. The manufacturers counter that the assistance programs are necessary if patients are to receive effective medications that would otherwise be unaffordable because insurance benefit design has left patients exposed to the cost of expensive drugs. With accumulators, the value of the copay assistance program isn’t counted toward patients’ deductibles. With maximizers, patient copayment and coinsurance are calibrated so they matches the value of the manufacturer’s drug assistance program.

The researchers at Janssen, which is part of Johnson & Johnson, started their research with an IQVIA data set that included more than 72 million patients. After applying exclusions , included some related to incomplete data, their analysis wound up using 156,720 “traditional “ patients with coverage not affected by one of the PBM copay adjustment programs, 8,356 patients affected by an accumulator program, and the 7,298 affected by a maximizer.

Ingham and his colleagues found no difference in the use of copay cards between White and non-White patients. The difference came when they looked at patients affected by accumulator and maximizer programs. They reported that non-White patients were 31% more likely to be “exposed” to accumulators than White patient and 27% more likely to be exposed o maximizers.

Ingham and his colleagues said accumulators and maximizers are associated with drug cost burden. “This risks penalizing patients with high deductibles or those with high drug us,” the poster says.