Providers and Patients Push Back, Payers Push Forward—Co-pay Mitigation Programs

AJMC

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By Chance Scott, Kathryne Kirk, and Joyce Wang, Guidehouse 

While research shows a trend toward increased payer implementation of co-pay mitigation programs, state legislation and advocacy efforts may suppress the actual utilization of these programs. Based on these findings, there are multiple key areas to explore:

Monitoring the legislative and health plan landscape to understand state level exposure to these programs Guidance to patient support services and field reimbursement managers on communicating impact Assessment of implications on government pricing (eg, Medicaid Best Price, Average Sales Price calculations) Though the future of the co-pay landscape remains uncertain, communication and collaboration across all stakeholders will be required to prevent increasing pharmaceutical OOP burden from hurting those they were meant to help: the patients.

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