Learn about the how recent economic and environmental factors affect Charitable Copay Assistance Foundations
The global economic landscape has been ever shifting, with numerous macroeconomic challenges arising from various sources. For Charitable Copay Assistance Foundations that provide financial support to patients facing high out-of-pocket costs, rely heavily on funding from drug manufacturers and private donations to run their operations, these shifts have led to a myriad of obstacles. In recent times, rising inflation, staffing challenges and the variability of funding availability have severely impacted these organizations.
1. Rising Inflation
Inflation erodes the purchasing power of money. For individuals and corporations, this means that the cost of living and operating businesses rises. For non-profits, it translates to:
2. Staffing Challenges
Human resources are the backbone of many non-profit foundations, and they are not immune to the challenges the current job market presents.
3. Variance of Funding Availability
The availability of funds for Charitable Copay Assistance Foundations is becoming increasingly unpredictable, mainly due to:
Impact of Copay Maximizers and Accumulators
Accumulators prevent 3rd party dollars (foundation or drug manufacturer programs) from counting towards a patient’s deductible and maximum out-of-pocket limit which enables plans to double dip on deductibles as rebate arrangements. This shrinks the dollars available because patients are utilizing more assistance given the initial assistance isn’t counting towards their deductible. Many 501(c)(3) non-profit and patient advocacy groups, as well as provider organizations, have advocated against accumulators. The advocacy effort has been effective and state legislators are passing bills banning the use of accumulator programs. As of July 2023, 19 states have banned this strategy for state-regulated health plans.
The largest impact to copay assistance programs has been copay maximizer programs which is a feature within a health insurance plan where drug manufacturer payments do not count toward the patient’s deductible and out-of-pocket maximum. With a copay maximizer program, health insurance plans set the patient’s copay to reflect the annual patient assistance available from the drug manufacturer. The net result is money from patient assistance programs is effectively utilized by the health plans rather than by patients and reduces the overall supply available in the market for patients in need. In 2023, we have seen some drug manufacturers modify their copay program eligibility criteria and exclude patients whose commercial insurance plan includes a copay maximizer program which accounts for 76% of plans.
Patients often don’t know where to turn to be able to afford their medication. Charitable Copay Assistance Foundations can play an important role since they don’t have as many limitations on the patient assistance they can provide when patients are in a copay accumulator or maximizer program. However, it’s challenging for providers to access these foundations since there are thousands and searching for them is a very manual process.
A key step for providers in accessing these foundations is to utilize technology that actively searches for these foundations, checks the status of funding availability and automatically matches patients to the best program for their needs.