Impact of Co-pay Accumulator Adjustor Programs on Specialty Drug Use

How do Co-pay Accumulator Adjustor Programs (CAAPs) affect the refill adherence and discontinuation of specialty medications?

Members in HDHPs with HSAs often meet their entire deductible within the first few months of the year if they are taking a specialty medication. Because of the need to have funds to cover this entire amount so early in the year, some members may utilize the help of manufacturer co-pay assistance.

When Co-pay Accumulator Adjustor Programs (CAAPs) are adopted by self-insured employers and health plans, this manufacturer co-pay support is not applied to member deductibles. These support programs are not unlimited, and many patients will exhaust the funds available before meeting their deductible requirements. The impact of CAAPs on specialty drug use, specifically autoimmune treatment, had not previously been evaluated. The objective of this study was to assess the impact of a CAAP on refill adherence and discontinuation for patients on specialty medications, specifically those for autoimmune conditions.

A study was conducted to evaluate the impact of these programs on members in HDHPs with HSAs, whose specialty medication was subject to a deductible. Data included Rx claims from ~150,000 lives across 15 employers. Of those lives, approximately 600 were members taking a specialty medication for autoimmune conditions. Comparisons were made between members in PPO plans and members in HDHPs with HSAs. In addition, the study evaluated two time periods: before and after implementation of the CAAP.

The highlights of the study include:

CAAPs have the potential to negatively affect autoimmune specialty drug use. Autoimmune patients enrolled in HSAs had lower refill adherence and significantly higher discontinuation vs. PPO enrollees post-CAAP implementation.

Discontinuation was not significantly affected by CAAPs when the medication was not subject to deductibles. Patients with MS who were enrolled in either an HSA or PPO did not experience a difference in absolute discontinuation rates, as those medications were on the Preventive Drug List

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