When these payments from manufacturers would max out for the year, patients' insurance would typically kick in since they've met their deductible or out-of-pocket maximums. With accumulator adjustments, patients receive the same amount of money from drugmakers as before, but the payments don't count toward patients' deductibles and out-of-pocket maximums.
So when they've hit the amount of money pharmaceutical companies chip in for the year, they're stuck paying the full cost for the drugs until they've reached their deductible or out-of-pocket maximums.
Those costs can be eye-popping because they're based on list prices, not the rates payers negotiate. Experts have said the practice could cause drug costs to fall because drug manufacturers will kick in more money to help buffer the sticker shock patients experience when their copay cards run out of money and they must pay out of pocket.
"The accumulators are targeting people who have rare diseases and take specialty drugs," said Adam Fein, CEO of Pembroke Consulting's Drug Channels Institute. "They're as much of a cash grab from patients as I can possibly imagine. They're being misrepresented by payers as choosing a brand versus generic, but these drugs don't have a generic."
Three categories of drugs have driven price increases, on a weighted basis, over the last six years: disease-modifying antirheumatic drugs, multiple sclerosis drugs and HIV drugs. This quarter, they all saw significant real net prices decline. DMARDs' prices decreased 5.8 percent, MS drugs fell 5 percent and HIV drugs fell 11.8 percent.