Pressure on Patient Assistance Programs | Predictions for 2025

With a new administration in place, many are focused on federal healthcare changes. But in 2025, the bigger challenges will come from how payers and states handle costs.

Commercial health plans are moving away from copays toward coinsurance and stricter formularies, which means more patients will rely on manufacturer assistance programs. If the HELP Copays Act doesn’t pass in 2024, it’s unlikely we’ll see changes in 2025, leaving accumulator programs unchecked.

A few more states might pass laws to protect patients, but large employer plans are expected to keep expanding cost-saving programs like accumulators and maximizers. Manufacturers will need to do more to educate patients and doctors on how these programs work and how to advocate for access when care is delayed or denied.

These changes will put more pressure on patient assistance programs. Drug manufacturers should plan ahead with clear program rules to avoid problems later. Success in 2025 will depend on understanding the product payer mix, benefit designs and patients’ ability to pay — both at launch and throughout the product life cycle.