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Over the past year, pharmacy benefit managers have deployed a new weapon against the widely used but controversial copay assistance programs that drug makers distribute to consumers. Clumsily called copay accumulators, these are raising a controversy of their own over concerns consumers will pay more for their medicines. And drug makers, meanwhile, worry about a big financial hit.

These accumulators, which target specialty medicines that are typically more expensive and are often injected or infused, do not count the value of any coupons toward out-of-pocket medicine costs that are applied toward deductibles. As a result, these accumulators are expected to cause drug spending to drop, according to Adam Fein, who wrote a useful primer on his Drug Channels blog


“I think of it as coercive switching,” said Peter Pitts, a former FDA associate commissioner who heads the Center for Medicine in the Public Interest, a think tank that is funded in part by the pharmaceutical industry. “It isn’t necessarily driving you to a less expensive medicine, but one where a payer makes more money. And the higher the copay, the lower compliance rates may go.”

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