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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">Commentary</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Article</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-10-18T13:09:52.244">October 18, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Breaking Down Co-Pay Accumulators, Maximizers and the Impact on Patients</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/laura-joszt">Laura Joszt, MA</a><span class="mx-1">,</span></span><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/logan-lutton">Logan Lutton</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Breaking Down Co-Pay Accumulators, Maximizers and the Impact on Patients" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" 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class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"><div class="related-landing sm:w-auto md:max-w-fit lg:w-[auto] md:text-center my-2 md:my-0 undefined"><a class="" href="/conference/amcp-nexus"><div class="mt-6"><span class="text-primary text-sm">Conference</span><span class="mx-1 text-sm">|</span><span class="text-sm text-blue-700 underline">AMCP Nexus: The Academy of Managed Care Pharmacy Nexus</span></div></a></div></div><p class="py-2 mb-2 text-sm italic text-gray-600">Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">Under co-pay accumulator and maximizer programs, financial assistance that is in place to help patients is redirected to benefit insurers more, with the potential to cause significant harm to patients, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.</p><p class="pb-2"></p><p class="pb-2"><em>This transcript has been lightly edited for clarity.</em></p><p class="pb-2"></p><p class="pb-2"><strong><span style="text-decoration:underline">Transcript</span></strong></p><p class="pb-2"><strong>How do co-pay accumulators and maximizers differ from one another and why did insurers start implementing them?</strong></p><p class="pb-2">I'm going to answer that in 3 parts. First, what are they? Second, why did insurers start implementing them? And third, how are they different?</p><p class="pb-2"></p><p class="pb-2">First, what are they? Co-pay accumulators and maximizers and alternative funding plans, which we're not talking about yet, are cost-shifting programs that redirect financial assistance that's intended for patients to insurers. So that's point 1.</p><p class="pb-2"></p><p class="pb-2">Point 2, why did insurers start implementing them? The simple reason for that is financial gain. If we take a step back and think about where did they come from, employers are increasingly adopting benefit designs like high-deductible health plans that are passing on a greater share of out-of-pocket costs to patients than ever before. This out-of-pocket burden can actually hurt patients. Studies have found that higher co-pays and out-of-pocket cost can lead to reduced medication adherence, worsening disease control, and increased hospitalizations. Some manufacturers have started implementing co-pay assistance programs, which are sometimes called patient assistance programs, or PAPs, and these are designed to help patient access and to mitigate against some of these adverse events that come about from the worsening financial out-of-pocket burden.</p><p class="pb-2"></p><p class="pb-2">This brings us back to insurers misappropriating co-pay assistance with co-pay accumulators and maximizers. Co-pay accumulators and maximizers are part of a troubling trend that we're seeing in the health care ecosystem where intermediaries and third parties are extracting value from pharmaceuticals and they're interfering with patients receiving that value. So that's part 2: Why did insurers start implementing these programs?</p><p class="pb-2"></p><p class="pb-2">Part 3 of the question, what are the differences between accumulators and maximizers? Quite simply, co-pay accumulators redirect, and co-pay maximizers maximize. Co-pay accumulators redirect copay assistance funds from the patient to the insurance plan. The way this works in practice is that an insured patient can use a co-pay assistance fund to help pay for their medication at the pharmacy, but—and this is the key part—that co-pay assistance does not count towards their deductible or out-of-pocket maximum. What happens is when the co-pay assistance is exhausted, then the patient is surprised to find out that they owe money towards their deductible, towards their out-of-pocket maximum. In the absence of the co-pay accumulator program, again that co-pay assistance they were getting from the manufacturer helped directly meet those financial obligations.</p><p class="pb-2"></p><p class="pb-2">A way to think about this is double dipping. Basically, with a co-pay accumulator program, an insurer is double dipping. First, they're collecting the value of the deductible from the co-pay assistance program, and then they're collecting it again from the patient. That's a co-pay accumulator.</p><p class="pb-2"></p><p class="pb-2">Co-pay maximizers layer onto that to maximize the available funds from the co-pay assistance program. What happens in a co-pay maximizer is the patient is required to register with a third party for a specific medication before they can access it at the pharmacy. That third party looks at the co-pay maximizer or the co-pay assistance program that's available and tries to figure out what is the maximum amount of assistance that could be obtained from this co-pay assistance program, and then advises the health insurance plan to set the patient’s co-pay at a level that will maximize that amount of benefit from the plan. So, they're collecting a much larger amount.</p><p class="pb-2"></p><p class="pb-2">Now, the financial good news for the patient is for this particular product, they generally owe very little. The co-pay assistance fund has taken care of it. But again, and this is the part that is often overlooked, that money that's coming in from the maximizer or from the co-pay assistance program under the maximizer does not count towards the patient’s cost sharing.</p><p class="pb-2"></p><p class="pb-2">In summary, manufacturer co-pay assistance programs are designed to help patients access and receive the value of their medication. The cost-shifting programs, like accumulators and maximizers, are designed to help insurers extract the value of that co-pay assistance for themselves, which can in turn significantly harm patients.</p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" style="scroll-snap-align:center;text-decoration:none" href="/view/targeted-therapies-genomic-profiling-revolutionize-breast-cancer-treatment"><div class="w-full 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style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah." title="Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah." sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=30 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=30 750w, 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=30 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=30" decoding="async" data-nimg="fill" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div class="w-full flex-wrap text-center text-sm mt-4 font-light no-underline text-white"></div></a></div></div><div class="relative block sm:hidden"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/shaping-the-future-of-cardiology-key-takeaways-from-aha-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/49c254ee4b48052a1a8384c9a7285c4f028cf08d-303x240.svg?fit=crop&auto=format" alt="This year marks the 100th year of the American Heart Association | image credit: www.heart.org" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/shaping-the-future-of-cardiology-key-takeaways-from-aha-2024?utm_source=www.ajmc.com&utm_medium=relatedContent">Shaping the Future of Cardiology: Key Takeaways From AHA 2024</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/shaping-the-future-of-cardiology-key-takeaways-from-aha-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Attendees of the centennial American Heart Association (AHA) conference commend the meeting's ability to bring together diverse, interdisciplinary perspectives from across the globe. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent">Operationalizing Bispecifics in Multiple Myeloma</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/laura-joszt">Laura Joszt, MA</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Tyler Sandahl, PharmD, of Mayo Clinic, and Michael Byrne, DO, of Tennessee Oncology, discuss practical advice for bringing bispecifics to the community.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/health-equity-access-weekly-roundup-november-23-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg?fit=crop&auto=format" alt="Center on Health Equity and Access" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 23rd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/health-equity-access-weekly-roundup-november-23-2024?utm_source=www.ajmc.com&utm_medium=relatedContent">Health Equity & Access Weekly Roundup: November 23, 2024</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/health-equity-access-weekly-roundup-november-23-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Americans are underinsured, even with employer-based health plans; a thorough critique of the lack of representation among Black patients in clinical trials showcases a persistent theme; systemic barriers in cardiology, breast cancer, and patent systems are examined.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent">Expert Insights on How Utilization Management Drives Physician Burnout</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">On this episode of Managed Care Cast, we speak with the author of a study published in the November 2024 issue of The American Journal of Managed Care® to explore the link between utilization management and physician burnout. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645.png?fit=crop&auto=format" alt="Elevating Value in Cancer Care With Innovations, Accessibility, Equity" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent">Elevating Value in Cancer Care With Innovations, Accessibility, Equity</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the IVBM Regional event in Denver, Colorado.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7d8eded1203db3c45d2048eda2588d1fec5d7133-6720x4480.jpg?fit=crop&auto=format" alt="Vaccination | Image credit: Prostock-studio - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv?utm_source=www.ajmc.com&utm_medium=relatedContent">HPV Vaccination Cost-Effective at Preventing Cervical Cancer in Patients With HIV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Women living with HIV can reduce their risk of cervical cancer using a human papillomavirus (HPV) vaccine that is both cost-effective and effective in preventing the virus.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/shaping-the-future-of-cardiology-key-takeaways-from-aha-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/49c254ee4b48052a1a8384c9a7285c4f028cf08d-303x240.svg?fit=crop&auto=format" alt="This year marks the 100th year of the American Heart Association | image credit: www.heart.org" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/shaping-the-future-of-cardiology-key-takeaways-from-aha-2024?utm_source=www.ajmc.com&utm_medium=relatedContent">Shaping the Future of Cardiology: Key Takeaways From AHA 2024</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/shaping-the-future-of-cardiology-key-takeaways-from-aha-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Attendees of the centennial American Heart Association (AHA) conference commend the meeting's ability to bring together diverse, interdisciplinary perspectives from across the globe. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent">Operationalizing Bispecifics in Multiple Myeloma</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/laura-joszt">Laura Joszt, MA</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Tyler Sandahl, PharmD, of Mayo Clinic, and Michael Byrne, DO, of Tennessee Oncology, discuss practical advice for bringing bispecifics to the community.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/health-equity-access-weekly-roundup-november-23-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg?fit=crop&auto=format" alt="Center on Health Equity and Access" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 23rd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/health-equity-access-weekly-roundup-november-23-2024?utm_source=www.ajmc.com&utm_medium=relatedContent">Health Equity & Access Weekly Roundup: November 23, 2024</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/health-equity-access-weekly-roundup-november-23-2024?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Americans are underinsured, even with employer-based health plans; a thorough critique of the lack of representation among Black patients in clinical trials showcases a persistent theme; systemic barriers in cardiology, breast cancer, and patent systems are examined.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent">Expert Insights on How Utilization Management Drives Physician Burnout</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">On this episode of Managed Care Cast, we speak with the author of a study published in the November 2024 issue of The American Journal of Managed Care® to explore the link between utilization management and physician burnout. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645.png?fit=crop&auto=format" alt="Elevating Value in Cancer Care With Innovations, Accessibility, Equity" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent">Elevating Value in Cancer Care With Innovations, Accessibility, Equity</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the IVBM Regional event in Denver, Colorado.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7d8eded1203db3c45d2048eda2588d1fec5d7133-6720x4480.jpg?fit=crop&auto=format" alt="Vaccination | Image credit: Prostock-studio - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv?utm_source=www.ajmc.com&utm_medium=relatedContent">HPV Vaccination Cost-Effective at Preventing Cervical Cancer in Patients With HIV</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Women living with HIV can reduce their risk of cervical cancer using a human papillomavirus (HPV) vaccine that is both cost-effective and effective in preventing the virus.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Breaking Down Co-Pay Accumulators, Maximizers and the Impact on Patients","datePublished":"2024-10-18T13:09:52.244Z","dateModified":"2024-10-18T13:10:19Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/breaking-down-co-pay-accumulators-maximizers-and-the-impact-on-patients"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"copay,insurance,financial assistance","articleBody":"\n\nUnder co-pay accumulator and maximizer programs, financial assistance that is in place to help patients is redirected to benefit insurers more, with the potential to cause significant harm to patients, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.\n\n\n\nThis transcript has been lightly edited for clarity.\n\n\n\nTranscript\n\nHow do co-pay accumulators and maximizers differ from one another and why did insurers start implementing them?\n\nI'm going to answer that in 3 parts. First, what are they? Second, why did insurers start implementing them? And third, how are they different?\n\n\n\nFirst, what are they? Co-pay accumulators and maximizers and alternative funding plans, which we're not talking about yet, are cost-shifting programs that redirect financial assistance that's intended for patients to insurers. So that's point 1.\n\n\n\nPoint 2, why did insurers start implementing them? The simple reason for that is financial gain. If we take a step back and think about where did they come from, employers are increasingly adopting benefit designs like high-deductible health plans that are passing on a greater share of out-of-pocket costs to patients than ever before. This out-of-pocket burden can actually hurt patients. Studies have found that higher co-pays and out-of-pocket cost can lead to reduced medication adherence, worsening disease control, and increased hospitalizations. Some manufacturers have started implementing co-pay assistance programs, which are sometimes called patient assistance programs, or PAPs, and these are designed to help patient access and to mitigate against some of these adverse events that come about from the worsening financial out-of-pocket burden.\n\n\n\nThis brings us back to insurers misappropriating co-pay assistance with co-pay accumulators and maximizers. Co-pay accumulators and maximizers are part of a troubling trend that we're seeing in the health care ecosystem where intermediaries and third parties are extracting value from pharmaceuticals and they're interfering with patients receiving that value. So that's part 2: Why did insurers start implementing these programs?\n\n\n\nPart 3 of the question, what are the differences between accumulators and maximizers? Quite simply, co-pay accumulators redirect, and co-pay maximizers maximize. Co-pay accumulators redirect copay assistance funds from the patient to the insurance plan. The way this works in practice is that an insured patient can use a co-pay assistance fund to help pay for their medication at the pharmacy, but—and this is the key part—that co-pay assistance does not count towards their deductible or out-of-pocket maximum. What happens is when the co-pay assistance is exhausted, then the patient is surprised to find out that they owe money towards their deductible, towards their out-of-pocket maximum. In the absence of the co-pay accumulator program, again that co-pay assistance they were getting from the manufacturer helped directly meet those financial obligations.\n\n\n\nA way to think about this is double dipping. Basically, with a co-pay accumulator program, an insurer is double dipping. First, they're collecting the value of the deductible from the co-pay assistance program, and then they're collecting it again from the patient. That's a co-pay accumulator.\n\n\n\nCo-pay maximizers layer onto that to maximize the available funds from the co-pay assistance program. What happens in a co-pay maximizer is the patient is required to register with a third party for a specific medication before they can access it at the pharmacy. That third party looks at the co-pay maximizer or the co-pay assistance program that's available and tries to figure out what is the maximum amount of assistance that could be obtained from this co-pay assistance program, and then advises the health insurance plan to set the patient’s co-pay at a level that will maximize that amount of benefit from the plan. So, they're collecting a much larger amount.\n\n\n\nNow, the financial good news for the patient is for this particular product, they generally owe very little. The co-pay assistance fund has taken care of it. But again, and this is the part that is often overlooked, that money that's coming in from the maximizer or from the co-pay assistance program under the maximizer does not count towards the patient’s cost sharing.\n\n\n\nIn summary, manufacturer co-pay assistance programs are designed to help patients access and receive the value of their medication. The cost-shifting programs, like accumulators and maximizers, are designed to help insurers extract the value of that co-pay assistance for themselves, which can in turn significantly harm patients.","description":"Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.","author":[{"@type":"Person","name":"Laura Joszt, MA"},{"@type":"Person","name":"Logan Lutton"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" 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First, what are they? Second, why did insurers start implementing them? And third, how are they different?"}],"_type":"block","style":"normal","_key":"3a31a919d12c","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[]},{"_type":"block","style":"normal","_key":"b937d29b6f69","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"730f27140a030"}],"upload_doc":null,"uploadAudio":null,"medias":null},{"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"562d97f1d2f2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"First, what are they? Co-pay accumulators and maximizers and alternative funding plans, which we're not talking about yet, are cost-shifting programs that redirect financial assistance that's intended for patients to insurers. So that's point 1.","_key":"439d96a887b80"}]},{"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8ade16f86e550"}],"_type":"block","style":"normal","_key":"6c99fdb65482","upload_doc":null,"uploadAudio":null},{"medias":null,"children":[{"text":"Point 2, why did insurers start implementing them? The simple reason for that is financial gain. If we take a step back and think about where did they come from, employers are increasingly adopting benefit designs like high-deductible health plans that are passing on a greater share of out-of-pocket costs to patients than ever before. This out-of-pocket burden can actually hurt patients. Studies have found that higher co-pays and out-of-pocket cost can lead to reduced medication adherence, worsening disease control, and increased hospitalizations. Some manufacturers have started implementing co-pay assistance programs, which are sometimes called patient assistance programs, or PAPs, and these are designed to help patient access and to mitigate against some of these adverse events that come about from the worsening financial out-of-pocket burden.","_key":"572f30813b990","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"564b7a7900ad","markDefs":[],"upload_doc":null,"uploadAudio":null},{"medias":null,"children":[{"marks":[],"text":"","_key":"ef4348b516550","_type":"span"}],"_type":"block","style":"normal","_key":"af2e74687ad7","markDefs":[],"upload_doc":null,"uploadAudio":null},{"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"775bb699bdd2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"This brings us back to insurers misappropriating co-pay assistance with co-pay accumulators and maximizers. Co-pay accumulators and maximizers are part of a troubling trend that we're seeing in the health care ecosystem where intermediaries and third parties are extracting value from pharmaceuticals and they're interfering with patients receiving that value. So that's part 2: Why did insurers start implementing these programs?","_key":"3e64de2f91640"}]},{"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"cf187bb2bf6f","markDefs":[],"children":[{"text":"","_key":"d3279bccbd060","_type":"span","marks":[]}],"upload_doc":null},{"_key":"9571b31e7c28","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Part 3 of the question, what are the differences between accumulators and maximizers? Quite simply, co-pay accumulators redirect, and co-pay maximizers maximize. Co-pay accumulators redirect copay assistance funds from the patient to the insurance plan. The way this works in practice is that an insured patient can use a co-pay assistance fund to help pay for their medication at the pharmacy, but—and this is the key part—that co-pay assistance does not count towards their deductible or out-of-pocket maximum. What happens is when the co-pay assistance is exhausted, then the patient is surprised to find out that they owe money towards their deductible, towards their out-of-pocket maximum. In the absence of the co-pay accumulator program, again that co-pay assistance they were getting from the manufacturer helped directly meet those financial obligations.","_key":"28bf087c33c20"}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null},{"_type":"block","style":"normal","_key":"f563a1fd7b79","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1d18ce91e5770"}]},{"upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"a18c283610ab","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A way to think about this is double dipping. Basically, with a co-pay accumulator program, an insurer is double dipping. First, they're collecting the value of the deductible from the co-pay assistance program, and then they're collecting it again from the patient. That's a co-pay accumulator.","_key":"5e1b6bf323f90"}],"_type":"block"},{"medias":null,"_type":"block","style":"normal","_key":"5b15dacacaf5","markDefs":[],"children":[{"marks":[],"text":"","_key":"359eb446f6e10","_type":"span"}],"upload_doc":null,"uploadAudio":null},{"style":"normal","_key":"e208210b0741","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"Co-pay maximizers layer onto that to maximize the available funds from the co-pay assistance program. What happens in a co-pay maximizer is the patient is required to register with a third party for a specific medication before they can access it at the pharmacy. That third party looks at the co-pay maximizer or the co-pay assistance program that's available and tries to figure out what is the maximum amount of assistance that could be obtained from this co-pay assistance program, and then advises the health insurance plan to set the patient’s co-pay at a level that will maximize that amount of benefit from the plan. So, they're collecting a much larger amount.","_key":"f3476662dd1b0"}],"_type":"block"},{"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_key":"1b56018e569d0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"82f241f1a84f","upload_doc":null},{"_type":"block","style":"normal","_key":"df02712c227e","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"Now, the financial good news for the patient is for this particular product, they generally owe very little. The co-pay assistance fund has taken care of it. But again, and this is the part that is often overlooked, that money that's coming in from the maximizer or from the co-pay assistance program under the maximizer does not count towards the patient’s cost sharing.","_key":"6629c326ab7f0"}]},{"style":"normal","_key":"96c863d8ff8c","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"80d78eb47a510"}],"_type":"block"},{"_key":"786a602e1264","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In summary, manufacturer co-pay assistance programs are designed to help patients access and receive the value of their medication. The cost-shifting programs, like accumulators and maximizers, are designed to help insurers extract the value of that co-pay assistance for themselves, which can in turn significantly harm patients.","_key":"61b29994f4b30"}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null}],"title":"Breaking Down Co-Pay Accumulators, Maximizers and the Impact on Patients","issueGroup":null,"summary":"Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.","contentGroup":null,"pdfUrl":null,"_id":"dede4bf1-76f1-4f46-92ff-4b190d02e8b6","published":"2024-10-18T13:09:52.244Z","is_visible":true,"documentGroup":{"_rev":"WLDjX3DHIfSB0432T5XxZe","name":"AMCP Nexus: The Academy of Managed Care Pharmacy 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Scientific and educational sessions alike at this year’s meeting underscored the transformative potential of multidisciplinary collaboration, holistic care approaches, and novel innovations to advance the future of "},{"_type":"span","marks":["df208313cfce"],"text":"cardiovascular health","_key":"df69b018d9c9"},{"_type":"span","marks":[],"text":". Speakers discussed with ","_key":"a7ce7b2f5811"},{"_type":"span","marks":["em"],"text":"The American Journal of Managed Care","_key":"ad7874aca7c63"},{"_type":"span","marks":["superscript"],"text":"®","_key":"e75e12025349"},{"marks":["em"],"text":" ","_key":"8ce480b29dcf","_type":"span"},{"_type":"span","marks":[],"text":"the value of gathering expertise and facilitating conversations across these different disciplines to bring about new points of view and enhance research efforts and patient care.","_key":"ad7874aca7c64"}],"_type":"block","style":"normal","_key":"696f3acec24d"},{"children":[{"_type":"span","marks":[],"text":"","_key":"00962f736efc0"}],"_type":"block","style":"normal","_key":"98ed98549c71","markDefs":[]},{"_key":"da1154e331ba","markDefs":[{"_key":"cd1ede23214c","nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/gene-therapy"},{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/obesity","_key":"f477bc5780ca"}],"children":[{"text":"A common theme among attendees was the crucial role of forums like AHA to promote collaboration, networking, and the exchange of knowledge between industry leaders, researchers, and clinicians alike. Conferences like AHA create great opportunities to explore novel scientific innovations, including developments in ","_key":"f492b2de5e280","_type":"span","marks":[]},{"_type":"span","marks":["cd1ede23214c"],"text":"gene therapy","_key":"7b4f333dcbdc"},{"_type":"span","marks":[],"text":", ","_key":"4daf90d0e050"},{"_type":"span","marks":["f477bc5780ca"],"text":"anti-obesity medication","_key":"a5ef8a33bcc3"},{"_type":"span","marks":[],"text":", among others, all while presenting these findings in their applied context to demonstrate their impact on patient outcomes.","_key":"923d6baa13ae"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"bcf17a64b71a0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"3637a14f63f1"},{"_type":"block","style":"normal","_key":"0cf12aba9044","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Speakers emphasized the increasing importance of personalized medicine to account for patients’ unique risk factors and comorbidities, suggesting an end to the “one size fits all” era, and ushering in a new “renaissance” for cardiovascular medicine.","_key":"416657202ae10"}]},{"children":[{"text":"","_key":"f0b200431a450","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ce50ddda4ba8","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Furthermore, strong partnerships between industry and academia remain vital as clinicians, researchers, and leaders in cardiology continue driving progress in drug development, treatment approaches, diagnostic tools, and more. Overall, speakers expressed great optimism for the future of cardiology and a deep commitment to embracing innovation and interdisciplinary coordination for the betterment of patient care worldwide.","_key":"16ce717c431d0"}],"_type":"block","style":"normal","_key":"c6f2b2ff1f1f"},{"style":"normal","_key":"ba7e90356662","markDefs":[],"children":[{"_key":"3bf86c7673fe0","_type":"span","marks":[],"text":""}],"_type":"block"},{"_key":"04f52a731c1c","markDefs":[],"children":[{"_type":"span","marks":["em"],"text":"This transcript has been lightly edited for clarity.","_key":"30939eeb177e0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"714d44914a010","_type":"span"}],"_type":"block","style":"normal","_key":"f499bd698a43"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"How do you see the various research presented at AHA impacting your work or patient care?","_key":"741c963d2e030"}],"_type":"block","style":"normal","_key":"d918014f7de6"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2caa3bb88bff0"}],"_type":"block","style":"normal","_key":"267938d60fea"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Maureen Hood, PhD, RN","_key":"7b5a5c4452670"},{"_type":"span","marks":[],"text":": One of the reasons I like coming to this meeting is it brings together the researchers from all these different disciplines. I mean, cardiology is the big one that stands out because it's American Heart [Association], but there’s also radiology, neurology, nephrology, lifestyle interventions, the basic sciences, epidemiology—trying to figure out what's going on out there.","_key":"7b5a5c4452671"}],"_type":"block","style":"normal","_key":"916b80cdc5ed"},{"children":[{"_type":"span","marks":[],"text":"You get this group together, it's a very diverse group, and everyone's vying for their attention. But at the same time, I think people forget this is where we find the crossover ideas, where you can bring the professionals together. That's one of the areas where I am good at doing research. I have some good ideas, but I'm not an expert in the biomarkers. I'm not an expert in the advanced clinical imaging. So, I find those experts from those different areas.","_key":"86ba76fa9384"}],"_type":"block","style":"normal","_key":"fc4258755f37","markDefs":[]},{"_key":"e7b98aa763e1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Most of my research is multidisciplinary, and I think that is the forte of American Heart [Association]. It brings these different disciplines together in the same meeting, talking to one another, and in the planning of our sessions, we're talking to one another to bring in the expertise from the different areas on the topics that are important.","_key":"d1c8586499fd0"}],"_type":"block","style":"normal"},{"children":[{"text":"","_key":"cbc3fb4334180","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"a327c5cf04ca","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Cathie Biga, MSN, FACC","_key":"3ce5957d5ae10"},{"text":": The house of cardiology is critical, and not only AHA, ACC [American College of Cardiology], [Heart Rhythm Society], [Society for Cardiovascular Angiography \u0026 Interventions]—all of our societies together. The whole house of cardiology. It's imperative that we're all at that table, because the continuum of cardiovascular care not only has gotten enormously complicated, but the breadth and the depth and the rapidity of the change and the science that continues to astound as you listen to all the late-breaking trials—even here this morning already. That's what we need, and those ongoing, continuous educational opportunities will come together. Boards will never be stagnant. They will always be a dynamic process, and without meetings such as ACC and AHA, that wouldn't be able to happen.","_key":"3ce5957d5ae11","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"9360ff8e3013","markDefs":[]},{"_type":"block","style":"normal","_key":"dc7c47002673","markDefs":[],"children":[{"_type":"span","marks":[],"text":"So it's not just the networking and the presentation of the science, but it's really that in depth ability to be able to talk to the principal investigators, to really understand their research and the ins and the outs of it, and then that will then translate into perhaps exam questions or other vehicles that physicians can utilize in order to continue their maintenance of competency and certification.","_key":"d71b414e8e680"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"92ed2d7644da0"}],"_type":"block","style":"normal","_key":"965c76210367","markDefs":[]},{"_type":"block","style":"normal","_key":"14dcd173743c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Khadijah Breathett, MD","_key":"2d84722f55220"},{"_type":"span","marks":[],"text":": This is the centennial year—a wonderful time and place to be for global science to be presented. I think one of the great things about American Heart Association is that it's not just cardiologists. We have physicians from internal medicine to endocrinology to neurology, and the list goes on, and PhD scientists and master’s scientists all thinking about, “How can we improve the health of the heart for individuals in this nation and around the world?”","_key":"2d84722f55221"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"And the science is not just, like, I'm more of a clinical research and population health research, but there's also basic science and translational research. And so, it's really the whole gamut here, and it's a great opportunity to learn about the late breaking trials, and the things that you may be able to bring back home to your respective hospitals and clinics to improve the care of your patients. So, it's a great time to be here, and a great time for wonderful science.","_key":"328312c53cd70"}],"_type":"block","style":"normal","_key":"306a6c3c8eb6"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ef8fd2ffc0020"}],"_type":"block","style":"normal","_key":"b36806b7d323"},{"children":[{"_type":"span","marks":["strong"],"text":"Masanori Aikawa, MD, PhD","_key":"f911aa78305f0"},{"_type":"span","marks":[],"text":": What we have been trying to accomplish at the AHA meeting, and then what we should do more is, integration between clinicians and basic research scientists. You know, there are some sessions that feature both basic research scientists, for example, vascular biologist and cardiologist or cardiovascular surgeon, and to discuss 1 clinical program from different angles. This is extremely important, and then those scientists or clinicians from different disciplines should work together. Sometimes, practically speaking, it's not so easy to do. Everybody's busy, but this is something we really should do.","_key":"f911aa78305f1"}],"_type":"block","style":"normal","_key":"3df9b3ee0eff","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"Another aspect of this is a computational kind of method that has been developing very, very quickly. You know, that supports you. Our systems approach, for example. So therefore, in my group, we have biologists and computational data scientists who are working together in the shared space. This is 1 example of a integrated research approach: clinician and scientist and cardiovascular scientist and data scientist. We should all work together to ask 1 question and then try to resolve 1 problem together—and also academia and industry collaboration is very, very powerful to speed up the process of drug development. For example, diagnostics and the device companies are very, very powerful too. 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However, both he and Henschel acknowledged that this technology is still in its developmental stages and hasn’t realized its full potential.\n\n","_key":"11079cb00bba"},{"text":"Therapeutic Advances","_key":"3126b432dfd6","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":"\n","_key":"5f3f70057a5a"}]},{"widthP":25,"_type":"figure","alt":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers","_key":"c2d874e6bb9b","imgcaption":[{"style":"normal","_key":"15e4bbaf4e85","markDefs":[],"children":[{"marks":[],"text":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers","_key":"02aa1460fade","_type":"span"}],"_type":"block"}],"alignment":"left","disableLightBox":true,"disableTextWrap":false,"asset":{"_ref":"image-d447adb68e95c40a32b67a3e106204096ded2512-200x200-jpg","_type":"reference"}},{"_key":"716e82860d50","markDefs":[],"children":[{"marks":[],"text":"All IVBM sessions explore newer treatment methods that consider cost-effectiveness in cancer care. Amy Sidorski, MS, ANP-C, advanced practice provider for oncology and hematology at Rocky Mountain Cancer Centers, explained the evolution of multiple myeloma treatment within their practice over the past several years through the introduction of quadruplet therapy based on the phase 3 PERSEUS trial, which has altered first-line treatment for patients. Results from PERSEUS (NCT03710603), presented in December 2023 at the American Society of Hematology Annual Meeting and Exposition, showed that patients who received daratumumab (Darzalex), bortezomib (Velcade), lenalidomide (Revlimid), dexamethasone (D-VRd) induction/consolidation followed by daratumumab plus lenalidomide maintenance had lower risk of disease progression or death than the VRd group, and improved minimal residual disease negativity.","_key":"7375da5a57e8","_type":"span"},{"_type":"span","marks":["superscript"],"text":"3","_key":"64db89dd6b36"}],"_type":"block","style":"normal"},{"children":[{"_key":"23b660d7cdd5","_type":"span","marks":[],"text":"In addition, Sidorksi said, having chimeric antigen receptor (CAR) T-cell therapy and bispecific T-cell engagers for use in second-line treatment has changed her practices’ operations."}],"_type":"block","style":"normal","_key":"81de327a6fd5","markDefs":[]},{"markDefs":[],"children":[{"_key":"aa530af5a2f9","_type":"span","marks":[],"text":"“It’s an amazing time to be a myeloma doctor,” Jorge Monge, MD, assistant professor of medicine and hematology at the University of Colorado School of Medicine in Aurora, said. Monge emphasized advancements made in multiple myeloma treatment from 1985 to 2024, emphasizing that a key area of evolution has been in the patient’s quality of life."}],"_type":"block","style":"normal","_key":"c87eb11ebe11"},{"markDefs":[],"children":[{"text":"Lida Bighash, PharmD, BCOP, clinical pharmacy specialist in oncology at Denver Health, reviewed the past decade of advances in non–small cell lung cancer (NSCLC) treatment. As recently as a decade ago, there were no approved agents for use in NSCLC. Currently, there are several options for patients among all areas of NSCLC in neoadjuvant, adjuvant, and perioperative settings.","_key":"81e0b6b4e77a","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"1b1e6c212a25"},{"_key":"5910fde13802","_type":"figure","disableLightBox":true,"alt":"Tejas Patil, MD | Image: University of Colorado","widthP":25,"disableTextWrap":false,"imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Tejas Patil, MD | Image: University of Colorado","_key":"1b01259dcaf9"}],"_type":"block","style":"normal","_key":"f0a3f9ae75eb"}],"asset":{"_type":"reference","_ref":"image-53e969cbdbb7ddb733d3e127f4dbea8f818f7170-500x500-jpg"},"alignment":"left"},{"_key":"4eaf0b172016","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Tejas Patil, MD, oncologist and assistant professor at the University of Colorado Cancer Center agreed with Bighash on the focal areas of development, referring to CHECKMATE-816, KEYNOTE-671, CHECKMATE-77T, as well as other clinical trials that led to improvements in patients’ pathologic complete response.","_key":"68781585f8c9"},{"_type":"span","marks":["superscript"],"text":"4-6","_key":"8a1a82e6db12"}],"_type":"block","style":"normal"},{"_key":"751733a9f193","markDefs":[],"children":[{"marks":[],"text":"Virginia Borges, MD, professor of medicine and medical oncology at the University of Colorado, discussed the significance of ribociclib (Kisqali) in early breast cancer treatment based on results from the phase 3. NATALEE trial (NCT03701334).","_key":"8e6f5ff384a6","_type":"span"},{"_type":"span","marks":["superscript"],"text":"7","_key":"3d1893568deb"},{"_type":"span","marks":[],"text":" Borges explained patients with early-stage HR+/HER2-negative breast cancer have a pair of CDK4/6 inhibitor options for treatment: abemaciclib (Verzenio) or ribociclib, although she noted that some patients are unable to tolerate either therapy.","_key":"32fb5a0d994c"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"Financial toxicity was a theme mentioned across all panels because the best therapies can have high out-of-pocket costs. “The main factor that alters a woman’s life and drives the financial cost of treating breast cancer through the roof is a metastatic diagnosis,” Borges said.","_key":"0f5fc89c2441","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"afa16ed3c372"},{"markDefs":[],"children":[{"text":"She explained that a metastatic diagnosis includes higher-cost medications used for longer durations and in routine procedures, whereas a diagnosis of early-stage breast cancer is significantly less expensive. Borges referred to public support programs for patients who are uninsured or underinsured. Overall, she highlighted the cost-effectiveness of preventing metastatic breast cancer compared with treating it.","_key":"0911b1e95b11","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"382a9b62e3d2"},{"widthP":25,"disableLightBox":true,"_type":"figure","imgcaption":[{"_type":"block","style":"normal","_key":"f80a6e656336","markDefs":[],"children":[{"marks":[],"text":" Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn","_key":"6f03be26012b","_type":"span"}]}],"_key":"2ec27a02fe1e","asset":{"_ref":"image-2d330678dfcdd6731a1750cdad0d1e581842adda-200x200-jpg","_type":"reference"},"disableTextWrap":false,"alt":"Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn","alignment":"left"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The moderator for the multiple myeloma panel, Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, clinical pharmacy manager in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Health System, asked Sidorski and Monge about the cost-effectiveness of CAR T-cell therapies. Sidorski stressed the importance of affordable CAR T-cell therapies for patients with myeloma but agreed that access has not been easy. She hypothesized that CAR T-cell therapies may be a more cost-effective option that will allow patients to move forward from previous therapy, potentially saving money down the line.","_key":"70e023a00d29"}],"_type":"block","style":"normal","_key":"0c47fcb50c27"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Monge explained why it is important to determine the duration of treatment on bispecific therapies, because starting treatment earlier for patients who remain on therapy the same length as patients starting later will result in similar financial toxicities. Transparent communication with appropriate stakeholders was suggested to develop models of cost ineffectiveness, which included fixed durations of therapy or minimal residual disease–adapted therapy.","_key":"bb7f54650c5a"}],"_type":"block","style":"normal","_key":"be73d7e3003d"},{"_key":"b8b0f9679ce0","markDefs":[],"children":[{"marks":[],"text":"Both Patil and Bighash emphasized the importance in considering financial toxicity within NSCLC treatment, acknowledging how one affects the other. They suggested patient assistance programs created by drug manufacturers as proposed solutions to lower the high costs of immunotherapies.\n“There are a lot of trials that are looking at this question of de-escalation, which goes hand-in-hand with financial toxicity,” Patil said.","_key":"fabb7d1ae072","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"a40bf20eabe2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Bighash noted that if the institutions, insurance companies, or patients cannot pay out-of-pocket expenses for adequate care medications, then the patients are not receiving the best quality treatment from health care providers.\n\n","_key":"ddb9daa905ee"},{"marks":["strong"],"text":"Takeaways and Next Steps\n","_key":"3cc3820e940c","_type":"span"},{"_type":"span","marks":[],"text":"Moving forward, the cancer care community must continue to focus on developing innovative treatments, improving access to care, and addressing financial toxicity for patients. By working together, we can create a more equitable and effective cancer care system for all, panelists agreed.","_key":"d0562f193c8d"}]},{"style":"normal","_key":"f8a886b17e4a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“My best idea would be that we bridge the connection with people and then they make trips into the big city for what they need or [find] ways to get them to the city. Transportation [issues] can be overcome, but you can’t just bring very sophisticated care out everywhere. It’s just not economically feasible,” Balasky said in an interview with ","_key":"a06512dba397"},{"marks":["em"],"text":"AJMC","_key":"c4fb58bda4c7","_type":"span"},{"marks":[],"text":". \n\n","_key":"05d76c82066c","_type":"span"},{"text":"References","_key":"fc937ebfb1f8","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":"\n1. Eklund M, Broglio K, Yau C, Connor JT, Stover Fiscalini A, Esserman LJ. The WISDOM personalized breast cancer screening trial: simulation study to assess potential bias and analytic approaches. ","_key":"3ad47b83c420"},{"_type":"span","marks":["em"],"text":"JNCI Cancer Spectr","_key":"d4c09311b118"},{"_type":"span","marks":[],"text":". 2019;2(4):1-7. doi:10.1093/jncics/pky067\n2. Champion VL, Paskett ED, Stump TE, et al. Comparative effectiveness of 2 interventions to increase breast, cervical, and colorectal cancer screening among women in the rural US: a randomized clinical trial. ","_key":"b4cdaa20724d"},{"_key":"a7cb766f16b0","_type":"span","marks":["em"],"text":"JAMA Netw Open."},{"_type":"span","marks":[],"text":" 2023;6(4):e2311004. doi:10.1001/jamanetworkopen.2023.11004\n3. Sonneveld P, Dimopoulos M A, Boccadoro M, et al; PERSEUS Trial Investigators. Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2023;390(4):301-313. doi:10.1056/nejmoa2312054\n4. A neoadjuvant study of nivolumab plus ipilimumab or nivolumab plus chemotherapy versus chemotherapy alone in early stage non-small cell lung cancer (NSCLC) (CheckMate 816). Clinicaltrials.gov. October 16, 2023. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT02998528\n5. Efficacy and safety of pembrolizumab (MK-3475) with platinum doublet chemotherapy as neoadjuvant/adjuvant therapy for participants with resectable stage III, IIIA, and resectable IIIB (T3-4N2) non-small cell lung cancer (MK-3475-671/KEYNOTE-671). Clinicaltrials.gov. September 19, 2024. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT03425643\n6. A study of neoadjuvant chemotherapy plus nivolumab versus neoadjuvant chemotherapy plus placebo, followed by surgical removal and adjuvant treatment with nivolumab or placebo for participants with surgically removeable early stage non-small cell lung cancer. Clinicaltrials.gov. July 23, 2024. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT04025879\n7. A trial to evaluate efficacy and safety of ribociclib with endocrine therapy as adjuvant treatment in patients with HR+/HER2-early breast cancer (NATALEE). Clinicaltrials.gov. October 10, 2024. Accessed October 23, 2024. https://clinicaltrials.gov/study/NCT03701334","_key":"ab84ec6ac1a5"}],"_type":"block"}],"documentGroup":null,"documentGroupMapping":null,"factCheckAuthors":null,"pageNumber":"SP923-SP924","summary":"Coverage from the IVBM Regional event in Denver, Colorado.","contentCategory":{"_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2"},"ExcludeFromPubMedXML":false,"drugMentions":"{\"drug_mentions\": [\"daratumumab (Darzalex)\", \"bortezomib (Velcade)\", \"lenalidomide (Revlimid)\", \"dexamethasone (D-VRd)\", \"chimeric antigen receptor (CAR) T-cell therapy\", \"bispecific T-cell engagers\", \"ribociclib (Kisqali)\", \"abemaciclib (Verzenio)\", \"nivolumab\", \"ipilimumab\", \"pembrolizumab (MK-3475)\", \"platinum doublet chemotherapy\"]}","authorMapping":[{"_createdAt":"2023-11-22T18:35:06Z","_type":"author","biography":[{"style":"normal","_key":"3da8fced8696","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Cameron Santoro is an associate editor for ","_key":"93662c5c4cfd"},{"marks":["em"],"text":"The American Journal of Managed Care","_key":"213c257c1eca","_type":"span"},{"text":"®","_key":"f546acb0aa91","_type":"span","marks":["superscript"]},{"_key":"acd931edd707","_type":"span","marks":[],"text":" ("},{"_type":"span","marks":["em"],"text":"AJMC","_key":"843f7d4e787d"},{"_type":"span","marks":["superscript"],"text":"®","_key":"7c809e803edb"},{"text":"), AJMC.com, and The Center for Biosimilars","_key":"35b69a01dbbe","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"®","_key":"8ddca200bc46"},{"text":".","_key":"ba3cca6122e3","_type":"span","marks":[]}],"_type":"block"}],"profileImage":{"_type":"mainImage","alt":"Cameron Santoro","asset":{"_type":"reference","_ref":"image-6ae51a61642a5ecba7cf4085fe97e68814e3c917-430x430-png"}},"_updatedAt":"2024-05-20T19:28:22Z","firstName":"Cameron","lastName":"Santoro","displayName":"Cameron Santoro","_rev":"sgy4yN0CjmArmRDnE2KiNm","_id":"232836b2-a7d6-4cdd-8d7e-65ab104eaf06","url":{"current":"cameron-santoro","_type":"slug"}}],"_type":"article","gptTakeaways":"• Decentralized clinical trials and telemedicine are pivotal in addressing rural cancer care challenges, enhancing accessibility and patient outcomes.\n\n• Therapeutic advancements, such as CAR T-cell therapy and quadruplet therapy, are transforming multiple myeloma treatment, improving patient quality of life.\n\n• Financial toxicity in cancer care is a critical issue, necessitating cost-effective solutions and patient assistance programs to ensure equitable access to treatments.\n\n• Collaborative efforts and innovative strategies are essential to develop a more equitable and effective cancer care system, addressing accessibility and financial challenges.","published":"2024-11-21T17:23:00.000Z","is_visible":true,"issueSection":{"_ref":"cc663f4a-abe3-4db7-a6a8-502b2c7a6f4b","_type":"reference"},"taxonomyMapping":[{"summary":[{"style":"normal","_key":"f1088709f836","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"b477264366c1"},{"marks":["em"],"text":"AJMC","_key":"3a355a7e133a","_type":"span"},{"_type":"span","marks":["superscript"],"text":"®","_key":"a63fce3889ac"},{"_type":"span","marks":[],"text":" Multiple Myeloma compendium is a comprehensive resource for clinical news and expert insights for this cancer.","_key":"4063e54b1813"}],"_type":"block"}],"_rev":"J9E0v654gKdSlGLhTDCsAu","_updatedAt":"2023-11-03T18:19:22Z","parent":{"_id":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","identifier":"compendium","isMainTopic":true,"_createdAt":"2020-03-30T18:16:46Z","parent":null,"_type":"taxonomy","name":"Compendium","_updatedAt":"2024-04-09T09:14:18Z","_rev":"oruil6rlosjyltJbhrNMGF"},"perKeywordMapping":["Hematologic Cancer","Health Equity Diversity \u0026 Inclusion"],"identifier":"multiple-myeloma","_type":"taxonomy","name":"Multiple 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in cancer treatment, accessibility, and equity were central themes at a recent IVBM event. Discussions highlighted the challenges and advancements in rural cancer care, emphasizing the role of decentralized clinical trials and telemedicine. Therapeutic advances, including CAR T-cell therapy and quadruplet therapy for multiple myeloma, were explored. Financial toxicity remains a significant concern, with panelists advocating for cost-effective solutions and patient assistance programs. The event underscored the need for continued innovation, improved access, and collaborative efforts to create a more equitable cancer care system.","thumbnail":{"_type":"mainImage","asset":{"_type":"reference","_ref":"image-c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645-png"}},"factCheckAuthorMapping":null,"_id":"3ab0a249-35da-4929-895b-bc3bc50fe93c","authors":[{"displayName":"Cameron Santoro","url":"cameron-santoro"}],"url":"elevating-value-in-cancer-care-with-innovations-accessibility-equity","issueGroup":{"_ref":"477f9888-ea5b-4621-bb40-41487563b322","_type":"reference"},"audioUrl":"https://s3.us-east-1.amazonaws.com/ai-generated-audios/www.ajmc.com/3ab0a249-35da-4929-895b-bc3bc50fe93c_1732210014543.06803a02-47fd-4bc2-a9ed-621eeaa817e4.mp3","_updatedAt":"2024-11-21T21:50:05Z","title":"Elevating Value in Cancer Care With Innovations, Accessibility, Equity","_createdAt":"2024-11-21T17:26:47Z","articleType":"Publication","_rev":"HwE5PzPdkhb4dxbtVFC5If","targeting":{"content_placement":["compendium/multiple-myeloma","stakeholders/providers","stakeholders/payers","news","compendium/hematology"],"document_url":["elevating-value-in-cancer-care-with-innovations-accessibility-equity"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Venetoclax May Be an Option for Children With R/R AML, MDS ","url":{"_type":"slug","current":"venetoclax-may-be-an-option-for-children-with-r-r-aml-mds"},"thumbnail":{"_type":"mainImage","alt":"MDS wooden blocks held by hand in glove | Image Credit: © Sviatlana - stock.adobe.com","asset":{"_ref":"image-75f5ad09048956408787303005237932f9707c3c-5433x2890-jpg","_type":"reference"}},"published":"2024-11-27T21:11:00.000Z"},{"title":"US ADHD Stimulant Shortage Highlights Growing Challenges in Adult Treatment","url":{"current":"us-adhd-stimulant-shortage-highlights-growing-challenges-in-adult-treatment","_type":"slug"},"thumbnail":{"asset":{"_ref":"image-b6fb5039fb065b6265bd44eb4eb365c5b2c92738-3115x2076-jpg","_type":"reference"},"_type":"mainImage","alt":"medicine pills - Kwangmoozaa - stock.adobe.com.jpeg"},"published":"2024-11-27T20:13:49.018Z"},{"title":"Visual Acuity Improvements Found After Rehabilitation With Digital Video Games","url":{"current":"visual-acuity-improvements-found-after-rehabilitation-with-digital-video-games","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"Amblyopia | Image credit: sasha1806 - stock.adobe.com","caption":"Amblyopia | Image credit: sasha1806 - stock.adobe.com","asset":{"_ref":"image-d9c0de98eb4a3f1910624843a741d1a8cccbbabf-3784x2832-jpg","_type":"reference"}},"published":"2024-11-27T19:19:00.000Z"},{"title":"Facility Type Influences Antifibrotic Treatment Rates in Patients With IPF","url":{"current":"facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf","_type":"slug"},"thumbnail":{"alt":"Exterior of a hospital | Image Credit: Spiroview Inc. - stock.adobe.com","asset":{"_ref":"image-f1dd6b59e85295091f77dfc0c25fdeb8a9856a93-4592x3448-jpg","_type":"reference"},"_type":"mainImage"},"published":"2024-11-27T17:30:00.000Z"},{"title":"Decoding SMA Progression: HFMSE Analysis Spotlights Variability","url":{"current":"decoding-sma-progression-hfmse-analysis-spotlights-variability","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"Keeping track of subgroup variability in SMA will provide more robust, comparable data in the long term | image credit: Bartek - stock.adobe.com","caption":"Keeping track of subgroup variability in SMA will provide more robust, comparable data in the long term | image credit: Bartek - stock.adobe.com","asset":{"_ref":"image-16ff03fc3732bb1b18d238c8f8af52fac1f6476e-5696x3392-jpg","_type":"reference"}},"published":"2024-11-27T17:11:13.855Z"},{"title":"2025 GOLD Report: New Insights on COPD Risks, Management","url":{"current":"2025-gold-report-new-insights-on-copd-risks-management","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"COPD illustration | Image Credit: peterschreiber.media - stock.adobe.com","asset":{"_ref":"image-6418bb32610c66a6b058609e8b3c2d21368ccb96-4200x3900-jpg","_type":"reference"}},"published":"2024-11-27T17:00:00.000Z"}]},{"authorMapping":[{"_id":"15b1de57-6a71-4655-ba17-eeaa1c733634","url":{"current":"julia-bonavitacola","_type":"slug"},"lastName":"Bonavitacola","_createdAt":"2022-02-23T21:42:42Z","_rev":"sgy4yN0CjmArmRDnE2Khrz","_type":"author","biography":[{"_type":"block","style":"normal","_key":"106fd454900b","markDefs":[{"_type":"link","href":"https://www.linkedin.com/in/julia-bonavitacola-b5aa63171/","_key":"d45285824c6f"}],"children":[{"_type":"span","marks":[],"text":"Julia is an associate editor for The American Journal of Managed Care® (AJMC®) and joined AJMC® in 2022. She produces written and video content covering multiple disease states, and assists in the screening process for manuscripts submitted to AJMC®.","_key":"8a55e07516550"}]},{"children":[{"_key":"c2ef3167786d","_type":"span","marks":[],"text":"She has a BA in English language and literature from Rutgers University. You can connect with Julia on "},{"_type":"span","marks":["d45285824c6f"],"text":"LinkedIn","_key":"8a55e07516551"},{"marks":[],"text":".","_key":"8a55e07516552","_type":"span"}],"_type":"block","style":"normal","_key":"769839c11518","markDefs":[{"_key":"d45285824c6f","nofollow":true,"blank":true,"_type":"link","href":"https://www.linkedin.com/in/julia-bonavitacola-b5aa63171/"}]}],"profileImage":{"_type":"mainImage","alt":"Julia Bonavitacola","asset":{"_type":"reference","_ref":"image-fa6d7df41e3dda6f2ed66b65f3313ff5869748c2-430x430-png"}},"_updatedAt":"2024-05-20T19:27:55Z","firstName":"Julia","displayName":"Julia Bonavitacola"}],"_updatedAt":"2024-11-19T15:21:58Z","url":"hpv-vaccination-cost-effective-at-preventing-cervical-cancer-in-patients-with-hiv","contentCategory":{"name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory"},"gptSummary":"Gardasil 4 is identified as the most cost-effective HPV vaccination strategy for preventing cervical cancer in women with HIV aged 18 to 45. The study highlights the increased risk of cervical cancer in this demographic and the role of ART in enhancing vaccine cost-effectiveness. A decision-analytic Markov model evaluated various vaccination strategies, revealing that universal vaccination with Gardasil 4 significantly reduces genital warts and cervical cancer incidence. Limitations include lack of specific disease progression data and assumptions about vaccine efficacy and protection duration.","articleType":"News","seoTag":["HPV","HIV","cervical cancer"],"summary":"Women living with HIV can reduce their risk of cervical cancer using a human papillomavirus (HPV) vaccine that is both cost-effective and effective in preventing the virus.","audioUrl":"https://s3.us-east-1.amazonaws.com/ai-generated-audios/www.ajmc.com/ecbe7732-b088-427c-b0a6-83afd10044d4_1732029708204.da433cbc-03b1-4ec7-b952-2ba4a69cbd34.mp3","gptTakeaways":"• Gardasil 4 is the most cost-effective HPV vaccine for women with HIV aged 18-45, reducing cervical cancer and genital warts significantly.\n\n• ART adherence enhances the cost-effectiveness of HPV vaccination strategies, increasing the probability of being cost-effective from 40.94% to 65.35%.\n\n• The study used a decision-analytic Markov model to evaluate cost-effectiveness, considering various vaccination strategies and CD4 T-cell count levels.\n\n• Limitations include lack of specific disease progression data, potential overestimation of vaccine efficacy, and exclusion of herd immunity effects.","_type":"article","factCheckAuthorMapping":null,"factCheckAuthors":null,"documentGroup":null,"documentGroupMapping":null,"body":[{"style":"normal","_key":"a063dfc2a6df","markDefs":[{"_type":"link","href":"http://ajmc.com/compendium/hiv","_key":"be481d3ba800","blank":true}],"children":[{"text":"The human papillomavirus (HPV) vaccine, Gardasil 4, was found to be the optimal cost-effective strategy to prevent cervical cancer in women living with ","_key":"744f485de54e0","_type":"span","marks":[]},{"_type":"span","marks":["be481d3ba800"],"text":"HIV","_key":"744f485de54e1"},{"_type":"span","marks":[],"text":" aged 18 to 45 years, according to a study published in the ","_key":"744f485de54e2"},{"marks":["em"],"text":"International Journal of Cancer","_key":"744f485de54e3","_type":"span"},{"marks":[],"text":".","_key":"744f485de54e4","_type":"span"},{"_type":"span","marks":["superscript"],"text":"1","_key":"28be2ce5edd7"},{"_type":"span","marks":[],"text":" Higher adherence to antiretroviral therapy (ART) could help in making sure the vaccine is cost-effective.","_key":"9e99ca9de982"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"c34ecbc933df0","_type":"span"}],"_type":"block","style":"normal","_key":"0f8c9af4ae3d"},{"style":"normal","_key":"192b757b3b46","markDefs":[],"children":[{"marks":[],"text":"Women living with HIV are at a higher risk of HPV,","_key":"f5534197ac780","_type":"span"},{"text":"2","_key":"d9261211705b","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" including contracting the virus, persistence of the virus, and progression. This correlates to the risk of cervical cancer being 6 times higher in women living with HIV. ART has been used to reduce the risk of disease related to HPV through re-establishing the immune mechanisms in a patient with HIV. Preventing cervical cancer is best done through HPV vaccination, as HPV infection is estimated to be 15.6% in women living in China. This study aimed to assess the cost-effectiveness of different strategies for HPV vaccination in women living with HIV aged 18 to 45 years in China.","_key":"3f603c65def0"},{"text":"1","_key":"355717acaaac","_type":"span","marks":["superscript"]}],"_type":"block"},{"imgcaption":[{"_key":"479fd8728135","markDefs":[],"children":[{"_type":"span","marks":[],"text":"HPV vaccination could help in the cost-effectiveness of treatment for women with HIV | Image credit: Prostock-studio - stock.adobe.com","_key":"bb86c9c44e720"}],"_type":"block","style":"normal"}],"_key":"88485a1931d9","disableLightBox":true,"_type":"figure","alignment":"left","alt":"HPV vaccination could help in the cost-effectiveness of treatment for women with HIV | Image credit: Prostock-studio - stock.adobe.com","widthP":40,"disableTextWrap":false,"asset":{"_ref":"image-7d8eded1203db3c45d2048eda2588d1fec5d7133-6720x4480-jpg","_type":"reference"}},{"children":[{"_type":"span","marks":[],"text":"The economic evaluation was based on a decision-analytic Markov model, which evaluated the cost-effectiveness of various vaccinations for HPV from a health care provider perspective. The Markov model was used to simulate progression from HPV to cervical cancer. Participants were categorized into 3 groups based on their CD4 T-cell count levels: 500 or more cells/mm","_key":"efe145019e4a0"},{"_type":"span","marks":["superscript"],"text":"3","_key":"f255359add12"},{"_type":"span","marks":[],"text":", 200 to 500 cells/mm","_key":"caa8f421fc2b"},{"_type":"span","marks":["superscript"],"text":"3","_key":"65ec61e30235"},{"_type":"span","marks":[],"text":", and less than 200 cells/mm","_key":"bd986328556d"},{"_type":"span","marks":["superscript"],"text":"3","_key":"2155dc6f2240"},{"_key":"39df06fa6047","_type":"span","marks":[],"text":". Previous studies were used to model the progression and regression of HIV infection."}],"_type":"block","style":"normal","_key":"46d11531679d","markDefs":[]},{"style":"normal","_key":"7e8958ac30b3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"00b3d62891240"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"No HPV vaccination was defined as the status quo in women living with HIV. There were 27 other vaccination strategies with the 3 approved vaccines of Cecolin 2, Gardasil 4, and Gardasil 9, alongside 9 more strategies that combined Cecolin 9 vaccines. All strategies were aimed at different age groups. All costs were evaluated through quality-adjusted life-years (QALYs), with the incremental cost-effectiveness ratio (ICER) calculated as the incremental cost/QALY gained.","_key":"b9c5261e0e640"}],"_type":"block","style":"normal","_key":"ffd5d40ba1d8"},{"_type":"block","style":"normal","_key":"f0a0229e0074","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"56c10f9e95170"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The researchers found that, should the status quo remain without a scale-up of vaccinations in a 100,000 person cohort, 51.99% of women living with HIV would die of HIV, 35.10% would have genital warts, 0.36% of them would develop cervical cancer, and 63.66% of women who developed cervical cancer would die. This would cost $7.51 million in costs related to HPV and $3.34 billion for treatment related to HIV.","_key":"68a22ff8f81c0"}],"_type":"block","style":"normal","_key":"7cce864ebc0a"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2e6166884d440"}],"_type":"block","style":"normal","_key":"3daef4f57fde"},{"style":"normal","_key":"78f7505b0bde","markDefs":[],"children":[{"_key":"3ed226f2a2610","_type":"span","marks":[],"text":"The HPV vaccination strategies would cost an additional $0.20 million to $42.83 million but the cohort would gain between 6 to 989 QALYs through this spending. Strategies that focused on universal vaccination were more cost-effective compared with those that targeted specific subgroups. The most cost-effective strategy, based on willingness to pay, was the Gardasil 4 vaccination for all women living with HIV aged between 18 and 45 years (ICER $32,766/QALY gained). This was followed by Gardasil 4 for patients aged 18 to 35 years (ICER $27,891/QALY) and aged 18 to 25 years (ICER $20,671/QALY gained). Having all women living with HIV aged between 18 and 45 years vaccinated with Gardasil 4 would reduce genital warts by 35.52%, cervical cancers by 12.96%, and deaths due to cervical cancer by 12.39%. All strategies would increase in the probability of being cost-effective from 40.94% to 65.35% if ART adherence increases to 100%."}],"_type":"block"},{"_key":"e3ec8ceb1650","markDefs":[],"children":[{"marks":[],"text":"","_key":"d2a7dfcf6b680","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"c97983c86b5b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"There were some limitations to this study. There were no prevalence parameters or probability of disease progression specifically for diseases related to HPV. The potential cross-protection of the vaccine was not taken into account, including other diseases related to HPV. Herd immunity was not taken into account. The effect of HPV infection was not incorporated into HIV disease progression. The accuracy of the results could have been affected by estimating the efficacy based on general women rather than women living with HIV. The vaccine may have been overestimated with the assumption that it would provide lifelong protection.","_key":"79cfbef296770"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"7e56a967c4170","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"d029bbf480fd"},{"children":[{"_key":"b4adb77c3d3a0","_type":"span","marks":[],"text":"The researchers concluded that the optimal cost-effective strategy for prevention of both genital warts and cervical cancer in women living with HIV aged 18 to 45 years was the use of Gardasil 4 vaccination. The probability of the strategy being cost-effective would increase with improved adherence to ART."}],"_type":"block","style":"normal","_key":"ad4949890768","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"d4fa47e856f10"}],"_type":"block","style":"normal","_key":"3786a94b2426","markDefs":[]},{"_key":"7eb0b350fc2c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"0eaf5e97368c0"}],"_type":"block","style":"normal"},{"listItem":"number","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Liu H, Zou M, Shen M, et al. HPV vaccination is highly effective and cost-effective for cervical cancer prevention in women living with HIV in China: a cost-effectiveness analysis. ","_key":"fc2d8e66cc3d0"},{"_type":"span","marks":["em"],"text":"Int J Cancer","_key":"fc2d8e66cc3d1"},{"_type":"span","marks":[],"text":". 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