The Impact of Copay Accumulator Programs on Autoimmune Specialty Drug Use

A team of researchers found that patients with health savings accounts (HSAs) who are on autoimmune drugs had a significantly higher risk for discontinuation, lower proportion of days covered, and lower monthly fill rates after implementation of a copay accumulator adjustment program (CAAP).

In an effort to limit pharmaceutical manufacture copay support applied toward a patient’s deductible, CAAPs are offered by pharmacy benefit managers to health plans and self-insured employers. However, their impact on specialty drug use was unknown. 

To assess the impact of CAAPs on treatment discontinuation, adherence, and monthly fills for patients on a specialty drug for an autoimmune indication, researchers used a convenience sample of data from the pharmacy benefit manager Conduent for January 2017 to October 2017.  The sample included more than 150,000 individuals from 15 self-insured employers initiating a CAAP in January 2017.

“Patients with a claim for an autoimmune specialty drug and continuous coverage under an HSA or preferred provider organization (PPO) plan were included in the analysis,” the research team, led by Bruce Sherman, MD, clinical faculty in the department of medicine at the Case Western Reserve University School of Medicine, and colleagues explained.

“Compared with PPO patients, HSA enrollees were expected to experience a greater impact from CAAPs due to high deductibles. Discontinuation (≥60-day gap in therapy), absolute discontinuation (discontinuation without observed restart or switch), proportion of days covered, and monthly fill trends were measured.”

The researchers evaluated a total of 365 HSA patients and 238 PPO patients. According to the findings, time to treatment discontinuation and risk of treatment discontinuation were significantly shorter and greater, respectively, after CAAP implementation for HSA patients compared with PPO patients.

The researchers found that absolute discontinuation was significantly higher for HSA vs PPO (29.5% vs 7.1%). Further, 10 months after the start of the copay program, proportion of days covered was significantly lower for HSA vs PPO patients. Researchers also found that HSA patients had 230 fewer autoimmune drug fills per 1000 patients vs PPO patients.

The researchers noted that prior to the CAAP implementation, metrics were not statistically difference between groups.

“HSA patients on autoimmune drugs had significantly higher risk for discontinuation, and lower PDC and monthly fill rates,” Dr Sherman and colleagues said. Ultimately, researchers concluded that CAAPs have the potential to negatively affect patients using specialty drugs for the treatment of autoimmune conditions.

These findings were presented at AMCP Nexus 2018.

—Julie Gould