The Changing Face of Patient Assistance Programs CE# 05-115-20-002-RN
10 Questions
The Changing Face of Patient Assistance Programs CE# 05-115-20-002-RN

As health care costs continue to climb and insurers look for new ways to shift costs, patients are feeling the pinch. Now a new payer mechanism, co-pay accumulators, is changing the way financial responsibility is calculated and taking many patients who use medication assistance programs by surprise.


This issue has been covered in health industry media as pharmacies that process claims through the pharmacy benefit see this unfortunate scenario play out. It’s becoming more common for customer service issues to arise when patients are informed that their out-of-pocket expenses for a medication are higher than anticipated. Because home and specialty infusion pharmacies, who process claims through both the pharmacy and medical benefit, could also encounter patients affected by co-pay accumulators, we offer this article as a primer on the topic.
  1. Trace the development of patient assistance programs.
  2. Understand the effects co-pay accumulators have on drug spend of payers, employers/plan sponsors, and patients.
  3. List legislative and regulatory developments aimed at curtailing the effects of co-pay accumulators on patients.
  4. Describe three steps provider reimbursement staff can take to educate patients about co-pay accumulators and offer options for minimizing their impact on out-of-pocket expenses.

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