CER Daily Newsfeed

The Hidden Costs of Co-Pay Assistance Programs: How Industry Practices Undermine Patient Access to Medications

(12/8, Brandy Fidler, BioXconomy) reports “...Co-pay accumulators and maximizers have become increasingly common. During the recent Access USA conference, Kimberly Westrich, chief strategy officer of the National Pharmaceutical Council, shared data indicating that these programs are becoming gradually widespread. According to the survey, 42% of employers have already implemented co-pay accumulator or maximizer programs, while an additional 8% are either considering or planning to adopt them soon. ‘Co-pay accumulators are when a patient who gets co-pay assistance finds that it doesn’t count toward their out-of-pocket cost,’ [Carl Schmid, executive director of the HIV and Hepatitis Policy Institute,] explained. ‘They really harm the patient because they have to come up with extra money to afford the drugs when they learn that the co-pay assistance didn’t count.’” Full

Value Viewpoint: December 5, 2025

(12/5, Kimberly Westrich, LinkedIn) comments “A research article published in Medical Decision Making examines trends in the inclusion of societal costs in cost-effectiveness analyses (CEAs) across 7,800 CEAs published from 2013 to 2023. Study authors found that only 24% included at least one societal cost component, though this share increased modestly over time from 19% to 28%. Productivity losses were most frequently included, followed by transportation, caregiver time, patient time, and consumption costs...The authors note that despite growing interest and clear impacts on economic results, societal costs remain inconsistently included, reflecting variation in HTA guidance, data availability, and methodological challenges.” Full

In CLL, Fixed-Duration Venetoclax Combos Are Equal to Continuous Ibrutinib in Head-to-Head Comparison

(12/6, Mary Caffrey, The American Journal of Managed Care) reports “...Fixed-duration regimens featuring the BCL2-inhibitor venetoclax (Venclexta; AbbVie/Genentech) offered patients with chronic lymphocytic leukemia (CLL) the same clinical benefit as an open-ended treatment with the Bruton tyrosine kinase (BTK) inhibitor ibrutinib (Imbruvica; Pharmacyclics/Janssen) in the first head-to-head trial comparing the 2 treatment strategies.” Full

The ‘Pharm-To-Table’ Movement For Prescription Drugs: Promising Or Performative?

(12/5, Brian Reid, Peter J. Neumann, Health Affairs Forefront) comments “...Direct-to-patient programs also offer a workaround to the growing number of formulary exclusions -- instances where a given health plan refuses to cover a specific medicine in favor of an alternative. This is often framed as a byproduct of hard negotiations, but it may mean that the right drug for the right patient is out of reach under the existing system due to insurance restrictions. Direct-to-patient solutions may help by giving patients the ability to bypass insurance altogether.” Full

UK-US Trade Deal: How New Value Set For HTAs Will Impact UK Drug Pricing

(12/8, Francesca Bruce, Pink Sheet) reports “...A new value set to be used by UK health technology appraisal body NICE is expected to impact the cost-effectiveness of some medicines and make room for higher drug prices.” Subscription Required