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.