Outcomes of accumulator/maximizer programs are varied | AMCP Annual 2026

Programs such as copay accumulators, maximizers, and other alternative funding programs may provide short-term savings but also may have unintended consequences that impact patient outcomes and adherence. Speakers today at a session at the Academy of Managed Care Pharmacy (AMCP) annual meeting in Nashville discussed how these programs work and what evidence shows about their impact.

“Savings doesn’t equal value,” said Patty Taddei-Allen, Pharm.D., clinical assistant professor, University of Florida, during the session. “The evidence and experience show varied outcomes; many patients have benefited from these programs, and then you’ll hear about those who have not. It’s important to understand that outcomes are variable. Evaluating these programs really requires balancing those financial objectives along with operational and patient considerations.

Copay accumulator programs prevent manufacturer-issued assistance cards from counting toward a patient’s deductible or out-of-pocket maximum. Maximizer programs spread the manufacturer assistance evenly across the benefit year to extract its full value and even out the patient copay. Alternative funding programs carve specialty drugs out of the benefit entirely and redirect patients toward manufacturer assistance and charitable foundations.

Billy Schnell, Pharm.D., manager, clinical strategy and services at Abarca Health, pointed out during the session that accumulator and maximizer programs change who pays, when they pay and what gets counted. “Gross spend reduction doesn’t equal net plan savings,” he said. “Savings depend on external funding approval rate, vendor fee structure, and rules when funding fails.”

He said that these programs don’t live in isolation and can impact all stakeholders. Providers may be required to complete additional paperwork such as patient assistance program forms. Manufacturers are trying to preserve access while controlling the scale and use of these programs. PBMs are balancing formulary strategy and rebate economics.

“And patients are navigating continuity, and these programs have actually introduced confusion, abrupt cost changes, and a lot of complexity to it,” he said. “Outcomes, including delays and abandonment, don’t occur randomly. They follow from the predictable stress points.”

Patients already don’t understand their benefit, Taddei-Allen noted. “When you add a much more complex level on top of that, patients can become even more disengaged from their healthcare.”

During the session, Taddei-Allen discussed the results of several studies that looked at the outcomes of alternative programs. One of these was a retrospective study of 603 patients in high-deductible plans compared with PPO enrollees. This analysis found that copay accumulator programs were associated with a 20 percentage-point increase in treatment discontinuation among patients enrolled in high-deductible health plans and an 11.7% lower patient adherence.

A separate analysis of nearly 6,000 commercially insured patients taking therapies for autoimmune diseases, multiple sclerosis or oral oncolytic specialty drugs from 2018 to 2022. This analysis found that maximizer programs were linked to a 51% increase in patient financial liability for other healthcare services — MRIs, specialist visits, routine care — because manufacturer assistance that might have satisfied a deductible was instead redirected away from that purpose. Taddei-Allen said that although maximizer programs shield patients with high specialty drug costs, they significantly increase the financial burden for other healthcare costs.

She also cited a patient survey that found a mean wait time of 68 days between prescription and access to medication through these programs compared with the two days to two weeks typical of standard specialty pharmacy prior authorization. Nearly a quarter of surveyed patients reported their condition worsened during the delay. More than 3 in 5 patients learned the program existed only when their coverage was denied at the pharmacy counter.

Taddei-Allen ended the session saying that specialty drug benefit strategies are continuing to evolve as long as those financial pressures are in existence for payers and plan sponsors. and for patients. “Evaluating these programs really requires balancing those financial objectives along with operational and patient considerations.”