Encore! EP293: Game Theory Gone Wild: Co-pay Cards, Co-pay Accumulators, and Co-pay Maximizers, With Dea Belazi, PharmD, MPH, President and CEO of AscellaHealth

Game Theory Gone Wild: Co-pay Cards, Co-pay Accumulators, and Co-pay Maximizers, With Dea Belazi, PharmD, MPH, President and CEO of AscellaHealth (Encore! EP293)

In this Encore, Stacey Richter revisits her conversation with Dea Belazi, PharmD, MPH, president and CEO of AscellaHealth, about the escalating game-theory battle between Pharma's co-pay cards and PBMs' co-pay accumulators and maximizers — with patients caught in the middle.

WHAT YOU'LL LEARN

✅ Why drug abandonment happens, and how PBMs use it as leverage to extract rebates from Pharma

✅ How co-pay accumulators and maximizers emerged as PBMs' countermove to Pharma's co-pay discount cards

✅ Why this same leverage battle, once fought over small-molecule drugs, now plays out over six-figure specialty therapies

✅ How some PBMs' separate maximizer entities upcharge employer plan sponsors while extracting cash from Pharma

✅ What the proposed HELP Copays Act aims to address in this system

WHY THIS MATTERS

Co-pay accumulators and maximizers sound like obscure PBM plumbing, but they determine whether a patient can actually afford the "miracle drug" their doctor prescribed — and whether Pharma's high list prices get checked or emboldened by how much of the out-of-pocket burden shifts onto patients. Understanding this game theory is essential for any plan sponsor trying to figure out who's actually benefiting from their benefit design.

MENTIONED IN THIS EPISODE

EP241 with Vinay Patel: Apple Podcasts | Spotify | Other Apps (link unavailable)

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction

11:06 "The concept of co-pay accumulators wasn't just a…PBM thought, but it also came from their customers, whether it was health plans or employer groups."

15:50 "[This is] literally a math problem based on, 'Do I spend it now? Do I spend it later?'"

17:20 What reason do employers and payers have for doing this?

21:13 "This is another mechanism for payers to push down additional cost to both the patient and now the pharma company."

22:24 EP241 with Vinay Patel.

22:59 "I don't think accumulators are really forcing Pharma to be more competitive."

25:06 How co-pay maximizers are different from co-pay accumulators.

28:09 Who doesn't like co-pay accumulators and maximizers?

30:01 How patient advocacy groups are a different model.

32:10 What is the biggest challenge facing employers right now?