How do copay adjustment programs impact racial and ethnic inequities? New research explores the surprising and troubling effects.
When commercial insurers in the US make co-pays unaffordable for patients, drug manufacturers often fill the gap, providing co-pay support directly to patients. But due to the dramatic increase in co-pay adjustment programs, also known as accumulators and maximizers, insurers block it from counting toward patients’ deductibles. In many cases, patients are stuck with surprise costs. Nationwide, 64% of all individual health plans available on the marketplace include CAPs.
We conducted a unique analysis of commercial payer data to assess the prevalence of co-pay card utilization, the application of CAPs and whether this varies by race and ethnicity. What we uncovered was surprising and troubling.
While non-white patients were as likely to use co-pay cards as white patients, non-White patients were 31% and 27% more likely to be placed into accumulators or maximizers, respectively, than their white counterparts. This means that benefit plans imposing CAPs pose a disproportionate burden on historically marginalized populations and people of color, further exacerbating existing health disparities.
This research was funded by Johnson & Johnson Innovative Medicine and conducted in collaboration with Patrick Mayne, a former IQVIA analyst, and Panita Maturavongsadit of Lumanity Communications. For full details on the study design, methods and limitations, see: Ingham M, et al. Assessment of racial and ethnic inequities in copay card utilization and enrollment in copay adjustment programs. J Manag Care Spec Pharm. 2025; 29(9): 1084–1092 doi: 10.18553/jmcp.2023.23021