Copay Accumulators: A Terrible Concept That's Still Picking Up Steam

Every year, I think to myself: is this the year where public pressure finally gets so great that health plans can no longer get away with copay accumulators? Of all the weird tricks played by insurance companies, accumulators have got to be among the least defensible. 

I mean, the whole point is to harm patients, which ought not be a viable, long-term approach. (The fact that most of you probably find the preceding sentence to be hopelessly naive is a huge indictment of our system.)

And then, each year, Adam Fein at Drug Channels publishes data that shows that accumulator (and maximizer) use is up. This year’s data suggests that about 49% of all commercially covered lives are subject to an accumulator/maximizer, up from last year. As with all of Adam’s stuff, it’s worth reading the whole thing. 

It’s certainly possible that this will be the year that everything changes. We’re up to 19 states that ban accumulators, and I’d be remiss in not celebrating the legal decision restricting the practice. So maybe there will be a turning point.

The less-naive part of me fully expects that even if there is a turning point, it’ll be a turn toward maximizers or alternative funding programs (another let’s-screw-the-patient concept). 

But here’s to hope.

So I tallied up your votes on the poll yesterday, and the Pfizer commercial got a B- average. But votes didn’t come in on a bell curve: either you really liked the spot or you really hated it. Lots of As, lots of Ds and Fs, not a lot of Cs. 

My guess is that it was a Rorschach test for your views on pharma’s business practices and commitment to science more than a commentary on the aesthetics of the ad itself. If you like the industry, you probably liked the commercial. If you don’t, you didn’t. And there’s really not a lot of middle ground.

• I said yesterday that I’d link to what I hoped would be a wave of good analysis of the first IRA decision, which dismissed the Texas case. I don’t know that it’s a perfect explanation, but this Bloomberg Law piece was more in-depth than any of the initial coverage. 

• I try not to get too knowledgable about Washington inside baseball -- I don’t want to damage my “I’m from the Real America” cred -- so I don’t know how much to read into this Washington Examiner op-ed from former Louisiana Governor Bobby Jindal and someone from the America First Policy Institute (which Wikipedia says is a “think tank that was founded in 2021 to promote former U.S. President Donald Trump's public policy agenda.”) The essay argues for a set of patent reforms, which makes me wonder how big a priority that topic would be should Trump re-take the White House. 

• The continued ability of Humira to maintain near-total control over its market -- a year after biosimilar competition began -- is clearly a market and policy failure. Julie Reed, who runs the Biosimilars Forum, makes that case clearly in this STAT First Opinion piece, suggesting that the policy move is to amp up PBM regulation.