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

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