Finding avenues to affordability for patients on specialty medications

While specialty medications are used by only 2% to 3% of the U.S. population, those treatments represent about one-third of the total cost of care.¹ The list price of an individual specialty prescription often is many thousands of dollars, while gene therapies and other highly sophisticated products can cost millions of dollars for a single treatment.

Without significant financial support, the cost of these life-changing – or lifesaving – medications would be out of reach for many of the people who rely on them.

Because affordability is vital, specialty pharmacies like Accredo by Evernorth should have a structure in place to match patients with appropriate copay assistance programs. These programs, which are primarily funded by pharmaceutical manufacturers and charitable organizations, cover most or all out-of-pocket obligations, including copayments, deductibles, coinsurance, and other cost-sharing requirements dictated by the patient’s benefit design.

Copay assistance programs help patients access the care they need

Accredo has been helping patients access copay assistance programs for more than 10 years. While some copay assistance programs are simple to access and intuitive to use, others can be challenging for patients to learn about, enroll in, and access funds. “That’s why we have staff and strategies to guide patients through every step of the process,” said Santosh Savel, senior director of specialty product development for Accredo.

When possible, Accredo helps patients enroll or enrolls them on their behalf. “Accredo proactively offers copay assistance information to patients who may be eligible,” Savel said. “In other instances, we can assist by directing them to the next step in the enrollment process, such as transferring their call to the copay assistance program or directing them to the program’s website or the portal set up by the drug manufacturer.” 

Mitigating social equity barriers 

While concerns about affordability are almost universal, patients impacted by social determinants of health (SDOH) also may need help mitigating barriers such as income inequality, insurance navigation, transportation issues, and access to specialty medications. Accredo Care Equity is an internal program that works to mitigate those barriers to care so every patient has an equitable opportunity to attain optimal health. In addition, Accredo is launching a partnership with TailorMed to help eligible patients seamlessly sign up for copay assistance for certain drugs. The partnership will eliminate time-consuming barriers and educate patients on the programs and how they work while providing an enhanced digital experience that increases self-service options. 

“In 2024 alone, Accredo helped 70% of its patients receive copay assistance, for a total of $2.9 billion,” Savel said. “As the costs of specialty medications continue to rise, Accredo specialty pharmacy continues its efforts to provide affordability.”