As pharmacy benefit managers (PBMs) expand the use of copay accumulators, copay maximizers, alternative funding programs, and prescription discount cards, specialty pharmacies are increasingly caught in benefit designs that shift financial risk while giving them little control.
In an article in Specialty Pharmacy Continuum, Jesse Dresser shared insight from his past ASHP Pharmacy Futures presentation. He explained that these programs shift risk from plans to manufacturers, patients, and often pharmacies, who may be left absorbing the cost of high-priced drugs dispensed under an alternative funding program. Jesse urged pharmacies to monitor how claims are adjudicated, identify when third-party programs are in play, and understand exactly what their contracts allow.
