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Focus on Managed Care Pharmacy

(M1) What You Need to Know About Copay Accumulators, Maximizers, and Alternative Funding Programs

Tuesday, October 15, 2024
8:30 AM – 9:45 AM PT
Location: 114
CPE
ACPE UAN:0233-0000-24-043-L04-P | Contact Hours: 1.25 | Activity Type: Knowledge-based
Employers looking to contain pharmacy benefit costs consider multiple specialty pharmacy management programs, including controversial copay accumulators, copay maximizers, and alternative funding programs (AFPs). Because the characteristics and legality of these programs are evolving, it is important that managed care pharmacy professionals have a baseline understanding of these programs, including how they may impact patient cost-sharing, access, and adherence to medications, and how legislative and regulatory developments and lawsuits could affect their implementation.

This session will include a deep dive into how accumulators, maximizers, and AFPs overlap and differ, why employers consider these programs and the challenges they may face, how these programs are regulated by CMS, data on the patient experience under these programs, how patient communities are responding to the programs’ adoption, and developments that may affect the legality and use of these programs in the next few years.

Learning Objectives:

At the completion of this activity, participants should be able to:
  1. Explain the differences and similarities between copay accumulators, maximizers, and AFPs.
  2. Describe the benefits and challenges of these programs for employers.
  3. Discuss how these programs affect patient cost-sharing, access to medication, and health outcomes.
  4. Summarize the ongoing legal, legislative, and regulatory actions that could affect these programs’ future implementation.