Payer Perspectives on the Cost of Copay Programs

By Corey Ford, MHA |

For manufacturers: Tactics for managing commercial copay assistance are gaining traction. Xcenda examines how it’s happening and what to expect.

Manufacturer-sponsored copay assistance programs exist to ease the often significant financial burden on patients. When the cost of specialty therapies can exceed thousands of dollars, this assistance can make all the difference in overcoming affordability and adherence barriers to improve health outcomes.

As more commercial payers assess copay programs for their impact on cost and formulary management, plans and PBMs may target—and restrict—financial assistance. In a new issue brief, Xcenda shares results from a survey of 46 national and regional commercial plans to reveal:

  • How many plans are limiting financial assistance now—and how much that number could grow over the next two years
  • The therapeutic areas most likely to be targeted by copay assistance restrictions
  • The models payers are using to limit financial assistance
  • The impact for patients and manufacturer programs

About the Author

Corey Ford

Corey Ford, MHA

Director, Reimbursement & Policy Insights
View Bio