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 interview, Renier Brentjens, MD, PhD, deputy director and chair of medicine at the Roswell Park Comprehensive Cancer Center, discusses:

How he has seen the field evolve since its inception, and what excites him most about its future

How the Roswell Park expansion helps improve patient access to CAR T-cell therapy

The key safety concerns associated with CAR T-cell therapy, along with how Roswell Park aims to mitigate potential risks

How Roswell Park is working to make CAR T-cell therapy more widely available

The steps needed to be taken at the regulatory and healthcare policy levels in order to support the broader adoption of CAR T-cell therapy

Renier Brentjens, MD, PhD outlines the evolution of the space, while offering ways to boost patient access to these treatments. 

Embarking on the CAR-T Journey

 interview, Brandon Newman, Xevant’s CEO and founder, explores:

The implications of the Inflation Reduction Act’s price negotiation provisions, and how these could result in ripple effects across the healthcare system

The role that pharmacy benefit managers (PBMs) and other intermediaries' play when it comes to determining drug costs, and how spread pricing is involved

How Xevant helps improve drug cost transparency efforts

Strategies for affordability Newman would offer the pharma industry that can be implemented immediately

Brandon Newman joins The Pharmaceutical Commerce Podcast to discuss the evolving role of PBMs, including the importance of drug price transparency. 

A Further Examination of Pharmacy Benefit Managers

The key strategies for reducing or eliminating post-prescription abandonment.

From Prescription to Patient: Four Ways to Increase Speed to Therapy 

A look at the prevailing factors impacting treatment access in 2025.

Healthcare Scorecard from Patients with Chronic Illness

How pharma manufacturers can steadily navigate GTN components and                                             complexities when planning pharmacy benefit reimbursement.

Popping the Gross-to-Net Bubble, Part III: The Pharmacy Benefit

A panel discussion breaks down ways for stakeholders to meet temperature-controlled operational demands pertaining to product pipelines.

LogiPharma Europe 2025: Aligning People, Process, and Technology

The telehealth company is offering Lilly’s branded form of tirzepatide—approved for weight loss—on its site for $1,899 a month, while Lilly also sells the GLP-1 via its LillyDirect platform.

Hims & Hers Begins Selling Zepbound

Building a Thriving Culture

, Kimberly Westrich, MD, chief strategy offer at the National Pharmaceutical Council, describes how in response to rising healthcare costs, employers have turned to high-deductible health plans and higher out-of-pocket (OOP) expenses, causing patients to pay more for healthcare. To help alleviate this financial burden, manufacturers offer copay assistance programs, which are aimed at improving medication adherence and preventing disease progression. However, insurers have introduced cost-shifting programs such as copay accumulators, maximizers, and alternative funding programs (AFPs) to manage these costs.

Copay accumulators redirect the value of copay assistance to the insurance plan instead of counting it toward the patient's OOP max or deductible. This means that patients face surprise copay costs once the copay assistance runs out, essentially "double dipping" as the plan captures the benefit without applying it to the patient's financial responsibility.

Copay maximizers also shift assistance from the patient to the plan but manipulate the patient's copay to extract the maximum benefit from the copay assistance. While the copay assistance helps with a specific medication, it doesn't count toward the patient's deductible or OOP max for other expenses, leaving the patient responsible for other costs.

Alternative funding programs (AFPs) are more complex. In these programs, certain specialty medications are removed from insurance coverage, and patients must enroll in an AFP. They work with a third-party vendor to obtain the medication, often through manufacturer assistance, charity programs, or international pharmacies. While the AFP may provide the medication, it can be a slow and confusing process, and patients may not qualify, leaving them to pay out of pocket or forgo the medication. These cost-shifting strategies aim to manage healthcare expenses but can create additional financial and logistical challenges for patients.

Westrich also comments on how these accumulators, maximizers, and alternative AFPs are impacting patients, manufacturers, and healthcare ecosystems; sessions that have caught her eye; and much more.

What other sessions have caught your eye at Hub and Specialty Pharmacy Models East?

Unfortunately, I wasn't able to be here for the entire conference. I really wish that I could have been, but I did have the fortune to attend the session—which was immediately before my session—and Dolores and Amanda from EMD Serono talked about their thriving culture.

This is the kind of session that you might not expect to sit in at a conference like this. I personally really enjoyed it. I have multiple hats at the National Pharmaceutical Council (NPC), and while one of my hats is looking at the employer-sponsored insurance world and doing policy relevant research, one of my other hats is related to culture, and I oversee our culture initiative at NPC.

Last year, we were chosen as a great place to work, and that's been really important and exciting to me, so in this particular session with Dolores and Amanda, I was really interested in hearing about the things that they've been doing to deliberately have an open culture, a culture that has shared values and cultural curiosity. It was really interesting for me to hear how another organization approaches it, to have that overlaid with this particular conference, because they also wove in some information about their PAP program and how all of this fits together, so I really enjoyed hearing that.

 anniversary last year, and I believe that one of the reasons that we are so successful—we have such longevity as an organization—is the focus that we put on our culture. I'm excited to take some of what I heard from Amanda and Dolores back to the office with me, and share some of their ideas with my colleagues and see how we continue to raise the bar—as Amanda and Dolores said today—on excellence.

In the final part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, comments on another presentation that has caught her eye at the conference. 

Latest Conference Coverage

Hubs East 2025: Building a Thriving Culture

Pushing Back Against Cost-Shifting Programs

What aspect of your presentation would you have wanted to dive further into?

One thing that I really would have liked to have spent a little bit more time on is this idea of what can we all do to help push back against these programs. There's something that everyone can do, so for employers, I would call on employers to really assess the ethical and the legal considerations, and to really think about whether or not these cost-shifting programs are meeting their objectives, because I believe if they really take a careful look at the considerations, the research, the impact, they will land on the side of ‘no, these are not programs that we want to be implementing.’ That's what employers could be doing. In terms of health plans, I wish health plans wouldn't use these programs at all. If they are going to use them, they should be transparent, There should be a way for patients to know I'm enrolled in an accumulator program. I'm enrolled in a maximizer program. This is what that means. This is how it's going to impact me.

I call on health health plans to be transparent. Government regulators can issue that tri-agency guidance that we're waiting for, which I would hope would support the patient copay assistance, counting towards the patient cost sharing, that's been in limbo for a while. Patients need that rule to come out, and they need it to be enforced.

Then finally, researchers can continue to do the research to look at what the impact of these programs are. We do have some research showing the harm that can come to patients as the disease progresses, as they're waiting, along with the potential health inequities. The more research that we have that definitively shows to all of these stakeholders the harm that these programs can cause, then the more evidence and ammunition we all have to curtail or stop their use.

In the third part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, details the aspect of her presentation that she would have wanted to dive further into.

Hubs East 2025: Pushing Back Against Cost-Shifting Programs

A Change in Healthcare Education and Provider Awareness

, Colin Banas, MD, DrFirst’s chief medical officer, describes have many Americans face significant challenges in accessing GLP-1 drugs due to their high cost. Despite the growing popularity and usage of these medications, which were originally developed for diabetes treatment, the price remains largely unchanged. Even with insurance coverage, patients often encounter co-pays or out-of-pocket expenses upwards of $500 to $600, making the medications unaffordable for many. Research indicates that once out-of-pocket costs exceed $100, medication adherence drops dramatically, further limiting access.

Additionally, insurance companies frequently require patients to try other medications first, a process known as step therapy, which can delay access to GLP-1 drugs. The drugs' weight loss benefits have garnered attention, but insurance companies still primarily cover them for diabetes treatment, leaving individuals seeking them for weight loss without coverage options. Moreover, as ongoing research uncovers more potential benefits of GLP-1 drugs—such as their positive effects on cardiovascular disease, Alzheimer's, and chronic kidney disease—insurance policies have not yet adapted to these expanded uses. As a result, many Americans who could benefit from these drugs for conditions beyond diabetes find that coverage is not available.

Banas also comments on patients turning to direct-to consumer (DTC) platforms following insurance denials; rumors of DTC advertising being banned; and much more.

What are your thoughts on the rumors that RFK Jr. could potentially ban DTC advertising?

As a provider it might be mixed, but there's actually an interesting consequence of DTC ads, and it is conversation and it is education, meaning, as a provider, I am also exposed to what my patients are being exposed to. I see the advertisement at the Super Bowl, or the flyer in the magazine or the web page. A lot of these therapies, a lot of these drug classes, are brand new and accelerating so quickly that it is actually very hard to keep up.

In a roundabout way, if I see that, and if I'm bombarded with it as a provider, I actually take that as a cue to, ‘oh, I need to educate myself,’ not necessarily on that drug in particular, but on that therapy class. The reason is, ‘wow, there's something new that's out there. I should be on top of it,’ and, ‘oh, I think I'm going to get questions about this.’ I do think that's an interesting side effect of DTC.

The other thing I'll say about RFK—there are a lot of things on pause right now. There's a lot of trepidation, especially in the health IT world. What is going to happen with existing road maps, around interoperability, around some of the CMS initiatives that providers are participating in? I will say it does seem to be a tech-forward administration, and so I do think there's going to be advances—maybe even accelerations—in artificial intelligence, hopefully in interoperability, and the digitization of the medical record. Because a lot of these things can't be accomplished without data, and you can't get the data unless you're collecting it, aggregating it, and using it in an appropriate way.

In the final part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Colin Banas, MD, DrFirst’s chief medical officer, shares his thoughts on the rumors that RFK Jr. could potentially ban DTC advertising.

Breaking Down the New Executive Order on Healthcare Price Transparency

Turquoise Health’s SVP of market solutions

 describes how the recent executive order on healthcare price transparency aims to make pricing in the healthcare industry more accessible and understandable for patients. This initiative is a continuation of efforts by both the Trump and Biden administrations, with the goal of improving transparency around hospital and payer reimbursement rates. The central idea is to require all hospitals and insurance companies to publicly disclose their contractual reimbursement rates, meaning patients will have clearer insights into what insurers pay hospitals for services.

Historically, these prices were not transparent, making it difficult for patients to understand the actual costs of healthcare. While earlier laws introduced in 2019 improved pricing transparency, there have been enforcement challenges. The new executive order seeks to address these issues by ensuring hospitals and payers comply with transparency requirements. A key update in the order is the inclusion of prescription drug prices, which had previously been excluded from transparency rules.

The broader impact of this order is to make healthcare pricing as transparent and predictable as other consumer services, like booking a flight or a haircut. Although the system is not fully realized yet, this executive order lays the foundation for a future where patients can easily access upfront pricing before seeking healthcare services. This transparency is expected to simplify the decision-making process for patients, ultimately fostering a more informed and competitive healthcare environment.

O’Dell also comments on the biggest challenges healthcare organizations currently face in terms of price transparency; where the healthcare industry currently stand in terms of compliance with price transparency regulations; specific strategies Turquoise Health provides in order to help healthcare providers navigate and meet the new price transparency requirements; and much more.

Can you explain the key provisions of the recently released executive order on healthcare price transparency and how it will impact the healthcare industry?

These executive orders are about price transparency, and this is not a new concept for the Trump administration or for the Biden administration for that matter. This happens to be one of the few bipartisan things perhaps that's out there. In essence, what they want to do is make all hospitals and all payers make all of their contractual reimbursement rates public. Those are complicated terms if you're not in the industry, but it basically just means, what is your insurer, as a patient, pay to the hospital for the service that you received? As wild as this sounds, until these price transparency laws were out, none of that ever existed.

That was all a guessing game, and no one had any visibility into it. Over the course of the last four years, since the first version of these laws came out in 2019, we've seen a lot better prices, and we've seen a lot better data on these—what does the payer pay to the hospital?

Why are we talking today? Why does this new executive order even need to happen? It's because first they feel that the laws have not been enforced enough. They're saying, these are good laws, but we need to really make sure that hospitals and payers are doing this, and we're going to enforce it if they're not doing it. The second thing that comes through is drug prices. Hospitals and insurance companies had to make all their rates available, but somehow, the pharmacy benefit drugs, or prescription drugs—as they reference in this executive order—squeaked away and didn't have to comply with the regulations.

They're coming back and saying, we're going to enforce and we're going to make sure that drug prices are visible. What does this mean for the whole healthcare industry? I actually agree with what I think the government believes here, which is that it makes it easier for a patient to understand what they're going to pay for healthcare services before they go in. They use this term of “guaranteed upfront prices,” and that's their government speak for saying it's as easy to go get healthcare services and know what you're going to pay as it is to book a flight or go get a haircut or whatever example you want to use—that's what they're going for. We are not there yet, but these are the building blocks and foundation that they're using to get there.

In the first part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, Turquoise Health’s SVP of market solutions, outlines the key provisions of the recently released executive order on healthcare price transparency.

Creating an Independent Patient Assistance Foundation 

 executive director at the Otsuka Patient Assistance Foundation, discusses two key sessions: "Establishing and Transitioning to a Foundation" and "Empowering Patients to Take Control of Their Healthcare." The first session focuses on the important aspects of transitioning to a foundation, emphasizing the risks associated with regulations and the need for robust patient support programs. The second session highlights the importance of guiding patients through their healthcare journey by removing barriers and enhancing their health literacy, helping them make informed health choices.

Thorpe outlines three critical factors when creating an independent patient assistance program (PAP) foundation: risk tolerance, conflict of interest, and funding stability. These factors are essential to ensure the successful operation and long-term sustainability of the foundation. She also stresses the importance of maintaining clear separation between the foundation and its core business operations, focusing on good stewardship and well-defined guidelines.

Thorpe emphasizes the significance of patient empowerment, noting that most patients struggle with understanding healthcare terms and concepts, with many having low health literacy. Empowering patients by improving their understanding of healthcare options is vital to help them make better health decisions.

Regarding digital innovation, Thorpe explains that while digital tools are crucial for patient engagement and literacy, they must be simple and engaging. Given the overwhelming digital landscape patients face, it’s important to create experiences that are easy to navigate and actively keep patients engaged, as prolonged use can be challenging. Simplifying digital interactions helps avoid patient fatigue and ensures long-term engagement.

What factors should be considered when creating an independent PAP foundation?

So with regard to how to transition a foundation, or if you're thinking about transitioning to an external foundation, there are three factors that you have to think through. One is risk tolerance—what the manufacturer’s risk tolerance is, what the future foundation’s risk tolerance is.

Secondly is conflict of interest. What are the some of the conflict of interests that are associated with the manufacturer and the foundation? And then, what is your funding stability? What is your long-term plan to sustain these programs indefinitely, or within the terms of the patient or product population?

In the second part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Rachel Thorpe, executive director at the Otsuka Patient Assistance Foundation, lays out the ways to begin transitioning a foundation. 

PAP 2025: Creating an Independent Patient Assistance Foundation 

How Various Programs Affect Patient Care and Health Equity

How are these accumulators, maximizers, and alternative funding programs impacting patients, manufacturers, and healthcare ecosystems, and how does this all tie into your presentation that you participated in?

These are having real impacts on patients, on employers, on the healthcare ecosystem. If we look at patients in particular, they are experiencing unexpected costs. They are experiencing negative health impacts when it comes to adherence and persistency concerns.

First of all, there's a huge lack of transparency surrounding these programs. Patients often do not even know that they're in one of these programs. They will be going to the pharmacy counter, and they will either get, in the case of an AFP, a surprise denial that they've got to navigate. With accumulators or maximizers, more often, they're getting their product covered, and all of a sudden, surprise, you have this financial obligation. And then what happens for many patients? There might be an adherence problem. They might not be able to afford their medication. They're confused. They're trying to navigate it. In a survey of patients who are enrolled in AFPs, they reported that there was a two-month delay in getting their medication, and during that two-month period, a quarter of those patients experienced worsening of their condition, disease progression. So that's real hardship that is occurring from these programs. 

Another consideration that a lot of people aren't really thinking about is the impact on health equity. These programs have the potential to exacerbate already existing health inequities. Research has shown that non-white patients are more likely to be enrolled in a copay accumulator program than white patients, and these programs are often targeting specialty medications that are intended for chronic conditions that are very serious, and you're having situations where vulnerable populations are experiencing disruption in care, which then has ripple effects on their health.

Maybe they end up going to the hospital, and then there's costs elsewhere. So these programs are in a situation where they can be exacerbating the health inequities that are already existing in our program that we would really like to be focusing on and improving, and given the potential for the harm that these programs can bring to patients. one of the things that we also explored in our session is, what can you do if you've got a problem, you don't want to just talk about the problem, you want to bring some potential solutions to the problem.

There are several things that are being done at the policy level, and I'll talk about what's happening at the federal level and what's happening at the state level. We published a primer in 

 earlier this week that looks at copay accumulators and maximizers, and goes into this more deeply than I'm about to here. I'm going oversimplify what's happening at the federal level and then at the state level. All of these programs are centering around not letting the copay assistance that comes from the manufacturer count towards the patient's out of pocket costs.

In the second part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, describes how accumulators, maximizers, and AFPs are impacting patients, manufacturers, and healthcare ecosystems, and how that all ties into the presentation she participated in.

Hubs East 2025: How Various Programs Affect Patient Care and Health Equity

Reasons Behind the Rising Popularity of DTC Online Prescription Services

As also noted by the iPrescribe survey, what are the primary reasons why 52% of respondents choose DTC online prescription platforms?

At first, I was like, ‘wow, that's crazy.’ And then I was like, ‘oh no, that actually makes sense.’ There are a couple things that come to mind. I'm still an actively practicing physician, although not nearly as comfortable in the outpatient space as I am on the inpatient space. I was a hospitalist, but a lot of patients may not want to bring these things up with their doctors. For whatever reason, a lot of patients may feel—like I spoke about earlier—that they're not going to qualify for that particular therapy, or that they've been down this path with their doctor before, and the doctor is just simply not going to prescribe it. ‘I've tried this before. My doctor is a stickler for this sort of thing.’ 

There’s a little bit of, I don't want to say gaming the system, but finding your sweet spot for your providers, and sometimes, whether it's comfort, whether it's the ability to access your primary care doctor, which I mentioned before can take months sometimes. The third thing—until recently, and the survey actually bears this out, but if you had asked me these questions two years ago, I would have almost guaranteed you that primary care doctors, internists, family doctors, were not writing for GLP-1s. I can almost guarantee it because it was this new diabetic medication that was on the scene, and I'm telling you that as an internist myself, there's a certain ‘we're comfortable with insulin, we're comfortable with metformin and glipizide,’ and maybe some of the other SGL2 inhibitors. I'm sorry I'm using all this jargon, but some of these other medications.

Once you hit a certain threshold, you're like, ‘I need an endocrinologist. I need a specialist. This is out of my comfort zone.’ And as the data started coming in, folks had to get more and more comfortable with it. You actually see internists prescribing this at a higher rate, year-over-year. You even see OBGYNs writing for these particular drugs, because a lot of times, women are using their OBGYNs as their primary care doctors, but two years ago, that wasn't the case.

You can imagine there's this sort of—as the industry catches up, or as folks get more and more comfortable with this—maybe patients don't realize that their doctor is indeed comfortable with this medication, and so they go looking for alternative. Again, not overly surprised. They certainly make it easy. It is easy to do these things on these DTC platforms, intentionally so.

In the third part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Colin Banas, MD, DrFirst’s chief medical officer, uncovers the main reasons why 52% of respondents choose DTC online prescription platforms.

The Growing Role of DTC Healthcare

An iPrescribe survey found that many patients turn to DTC platforms following insurance denials. How can these platforms address these challenges more effectively in order to better serve patients?

It's an interesting survey that you brought up, and there really were two big revelations that came out of it. I'm not sure that anybody would be surprised by them. Like you said, about a third of the time, it was related to cost as a reason to go DTC, whether it was insurance doesn't cover it, or out of pocket is simply too much when I go to my local retail pharmacy. The other one was convenience, which we can set aside and talk about in a second, but DTC is filling a need. I would consider it an access need.

It's providing a convenient way for access and options. In the old days, I had one option, I'm going to go to my doctor, and I'm going to wait to get on the waiting list. Maybe in six months, I'll finally get in to see them, and in my 15 minutes, I might be able to rattle off all of my chronic diseases and concerns, and maybe weight loss will bubble up to the top. Hopefully, if my doctor knows about this particular therapy, is comfortable with this therapy, and is educated, maybe I might qualify. You can imagine, as we've become so used to instant access in other areas of our lives—think about retail, think about banking, think about aviation—all these things are available at the touch of our app on a phone or a mobile device.

It becomes accessibility, it becomes option. And then there’s competition. In the United States, competition among all of these various accessibility options potentially leads to alternatives, whether it's alternative therapies, alternative costs, things like that. I am not surprised in the slightest that DTC has become a bigger and bigger portion of the way Americans seek healthcare. In fact, some of the pharmaceutical manufacturers actually are offering their own DTC now. I think of LillyDirect as one of the pioneers in that space.

In the second part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Colin Banas, MD, DrFirst’s chief medical officer, explains the rise in patients turning to DTC platforms following insurance denials.

Establishing and Transitioning to a Foundation 

You headlined the “Establishing and Transitioning to a Foundation” session, with a presentation on “Empowering Patients to Take Control of Their Healthcare” forthcoming. Could you provide a brief synopsis of both sessions?

So with regard to “Transitioning to a Foundation,” it really is more about what are some of the stewardships that you need when transitioning over, and what the risks are associated with the regulatory, and how you can build these programs to support patients. With regard to “Empowering Patients in Their Healthcare,” it's really about nurturing that patient journey, reducing barriers that they may face, and improving their literacy of their healthcare to help them understand what health choices they have.

In the first part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Rachel Thorpe, executive director at the Otsuka Patient Assistance Foundation, describes the various conference sessions that she participated in. 

PAP 2025: Establishing and Transitioning to a Foundation 

Understanding Copay Accumulators, Maximizers, and Alternative Funding Programs

chief strategy offer at the National Pharmaceutical Council

, describes how in response to rising healthcare costs, employers have turned to high-deductible health plans and higher out-of-pocket (OOP) expenses, causing patients to pay more for healthcare. To help alleviate this financial burden, manufacturers offer copay assistance programs, which are aimed at improving medication adherence and preventing disease progression. However, insurers have introduced cost-shifting programs such as copay accumulators, maximizers, and alternative funding programs (AFPs) to manage these costs.

What exactly are accumulators, maximizers, and alternative funding programs?

Before I define them, I'm going to step back and tell you a little bit about how we got here, where did they come from? As overall healthcare costs are going up, employers are looking for ways to manage their costs, and with some of the things that are happening to benefit design—we're seeing high- deductible health plans, we're seeing higher out-of-pocket (OOP) maxes, higher co-pays—patients are being asked to pay more than ever before, and then manufacturers are putting copay assistance in place to help mitigate some of the financial burden that patients are facing, because as they're facing that financial burden, there's problems with adherence and persistence, which can cause problems with disease progression, so manufacturers provide copay assistance, which helps patients manage this financial burden.

That brings us to cost shifting and these programs. What we're seeing is that insurers are increasingly using what we say are cost-shifting programs, and these programs are things like accumulators, maximizers, alternative funding programs. So, what are they? I will put these in my own words, kind of simplify it. We just published a primer in 

 earlier this week on copay accumulators and maximizers, which goes into a deep dive for anyone who wants to know more. For copay accumulators, I like to use the phrases redirecting and double dipping. The copay accumulators are redirecting the manufacture of copay assistance that's intended to patients.—it's redirecting it to the plans. What will happen is the patient will go to the pharmacy counter, the copay assistance card is covering the cost of their medications—like expected throughout the year—and then all of a sudden, there's a copay surprise, when the copay assistance runs out, and the patient is asked to pay the full cost. What has happened is the plan has captured the value of the copay assistance and not put that value towards the patient's out of pocket max, towards the patient's deductible. Then, the patient is asked to pay again, and that's where the double dipping part comes in. Before the copay accumulator was in existence, the patient would be able to meet their OOP max, their high deductible, with the copay assistance. With the copay accumulator, that copay assistance is shifted to the plan, and then the patient has to pay as well, double dipping. So that's the accumulator.

With the maximizers, the keyword here is maximizer. You've again got this shifting idea where the assistance is going from the patient to the plan, but the patient's copay is manipulated and set in such a way that the plan can extract the maximum amount from the manufacturer’s copay assistance. So that's the keyword, maximum. Here it gets a little tricky: copay assistance is not counting towards the patient's deductible, their OOP max, so for expenses other than the medication that's in the copay maximizer program, the patient is still having to pay their deductible, having to pay their copays in order to meet those expenses. They are, however, getting financial assistance from the copay assistance for that one particular product. So those are maximizers.

Then, we get to the alternative funding programs (AFPs), which are a little bit of a different bird shall we say. They still have this cost shifting idea. What happens with an alternative funding program is certain specialty medications are completely removed from the patient's insurance. They're not covered, so the patient appears to be uninsured for those products. And then what happens is they have to enroll in an AFP, and they work with a third-party vendor who then attempts to get the product for them from a manufacturer assistance program, from a charity, maybe from an international pharmacy. If they're successful in getting the product, then the patient gets the medication through the AFP, but it can take time. It can be very confusing for the patient. They might not qualify for these programs, and then they end up either having to pay out of their own pocket or going without their medication.

In the first part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, lays out the basics surrounding accumulators, maximizers, and AFPs. 

Patient Support

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