Preparing for 2023: piloting copay assistance through strong headwinds

Manufacturer-sponsored commercial copay assistance continues to face challenges from commercial payers and federal regulation. Most commercial payers now deploy an accumulator strategy, and in late 2020, the Centers for Medicare & Medicaid Services (CMS) finalized a Medicaid rule that holds significant implications for manufacturers offering copay assistance to commercial patients. In this rule, manufacturers must ensure that the full copay assistance benefit goes directly to the patient or face best price implications within Medicaid. CMS acknowledges that payer tactics such as copay accumulators prevent the full benefit from going directly to the patient. The effective date is January 1, 2023.

Given that this is a critical and timely challenge for the industry, many manufacturers are taking actions to mitigate the potential adverse impact on patients and their copay assistance programs.

Download our latest infographic that outlines the latest on copay accumulators, the industry action, and what steps you can take now to prepare for 2023.