Manufacturer Copay Assistance
Manufacturers of specialty drugs often provide copay assistance programs — paying the member's cost-sharing to improve adherence and market share. Without a copay accumulator program, the manufacturer's payment counts toward the member's deductible — effectively eliminating the member's cost-sharing. The employer bears the full drug cost while the manufacturer pays the member's share.
Copay Accumulator Programs
Copay accumulator programs prevent manufacturer copay assistance from counting toward the member's deductible. The member still receives the manufacturer's assistance — but it does not count toward their deductible. When the manufacturer's assistance runs out, the member must pay their full cost-sharing. Accumulator programs can save employers 5–15% on specialty drug costs.
Member Impact
Watch Out
Copay accumulator programs can leave members with unexpected costs when manufacturer assistance runs out. A member who has been paying $0 for their specialty drug (covered by manufacturer assistance) may suddenly face $500–$1,000 in cost-sharing when the assistance runs out mid-year. Communicate accumulator program rules clearly to members and provide financial counseling for affected members.