Related: Why Patients Want a Patient-First Pharmacy Benefit Among oncology patients, maximizer prevalence more than doubled from 5% to 13%. The proportion of commercial patients exposed to maximizers has tripled since 2019 in the autoimmune brands from 4% to 14%, as well as for multiple sclerosis products from 5% to 15%. Accumulator prevalence in multiple sclerosis increased more slowly for the one product IQVIA analyzed (17% to 20%). In the report on accumulators and maximizers, IQVIA found that from 2019 to 2022, the prevalence of accumulator programs doubled to 14% for autoimmune therapies and 20% for oncology products. Specialty medicines represent a growing part of drug spend, they are expected to be about 43% of global spending in 2027 and 56% of total spending in developed markets, according to the recently released report Global Use of Medicines 2023 from IQVIA. These programs maximize patients’ use of manufacturers’ copay assistance programs to limit the PBMs’ exposure to specialty drug costs. The use of copay accumulator and maximizer programs - mechanisms used by PBMs to reduce their spending on specialty drugs - has grown from 14% of commercially-insured patients in 2019 to 33% in 2022, according to a recent paper from IQVIA.Ĭopay accumulator programs do not allow pharmaceutical company coupons and copay assistance to count toward annual deductibles, while maximizers classify a subset of specialty medications as “non-essential,” which removes Affordable Care Act’s requirements related to maximum out-of-pocket limits.
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