Overcoming Payers’ Accumulator Adjustment Programs: A Key Step in Supporting Patient Access and Adherence

Affordability

 

Since the early 2000s, ConnectiveRx has stood shoulder-to-shoulder with drug manufacturers as they support patients struggling to afford essential medicines. One of payers’ more controversial threats to patient access and adherence is the accumulator adjustment program. While accumulator programs represent peril that is both real and substantive, the ConnectiveRx team leads the industry in the fight against them. 

We have developed a host of strategies to help patients access and afford their medications while helping brands stay within budget. In fact, we manage two of the first and largest programs (among others) designed to support patients and brands affected by payer accumulator adjustment tactics.

We help patients win the battle against payer-implemented accumulator adjustment programs. To do this, we rely on our experience managing copay programs, overcoming payer barriers, and analyzing our extensive claims data:

  • Subject matter experts monitor payer activity to identify therapeutic classes and products that may be targeted
  • Our legal team pays close attention to legislative and judicial activity to identify actions that affect the impact and enforcement of accumulator adjustment programs
  • We identify trends in our claims data then conduct in-depth analysis of product data alongside our brand partners
  • We model different financial scenarios to measure the potential impact of an accumulator adjustment program on a brand
  • Finally, we work with each brand to develop the most effective and least disruptive transition plan

Here’s a simplified view of our process, depicted in 3 steps. 

Step 1: Assess the Risk

Understanding the impact to the brand is the first step in designing a program that effectively, efficiently, and economically addresses the issue. Our highly-skilled team uses predictive analytics to track the medications and patient populations at risk of being pulled into an accumulator program. We consider the therapeutic area, the cost of the drug, its formulary status, and relevant anecdotal information to identify at risk patients. After quantifying the risk, that information is used to inform the options that are created in Step 2 of the process.

Step 2: Develop the Options

Our overarching predictive analytics systems recognize patients at risk and identify ways to mitigate the impact of PBM/payer accumulator adjustment programs. Models are customized to meet specific program goals, budget constraints, and legal requirements for each manufacturer. In addition to implementing interventions, we offer related data science models to optimize the interventions themselves (e.g., program offer analysis).

Step 3: Select and Implement the Solution

We work with the brand team to ensure the options and recommendations are understood before a final decision is made. A comprehensive, brand specific implementation plan is developed and executed. Each brand recommendation includes a unique offer statement, access strategy, and communication plan.

We truly believe our efforts to bypass payers’ accumulator-based tactics to be some of our most important work in our company’s mission to support patient access and adherence. To learn more about our approach to accumulator adjustment programs, see our latest Market Outlook Report.