# The Impact of Copay Accumulators and Maximizers on Treatment Patterns, Adherence, and Costs Among Patients with Major Depressive and Bipolar Disorders Treated with Branded Therapies

## TL;DR

This study examines how copay accumulator and maximizer programs affect treatment costs and adherence for patients with depression and bipolar disorder in the US.

## Contribution

The study provides new empirical evidence on the impact of copay accumulator and maximizer programs on mental health treatment outcomes and costs.

## Key findings

- Patients in copay accumulator and maximizer programs faced significantly higher out-of-pocket costs compared to standard copay plans.
- These programs were associated with poorer medication adherence and higher treatment discontinuation rates.
- Higher pharmacy costs were observed among patients with good adherence in accumulator and maximizer programs.

## Abstract

Copay accumulator (CA) and copay maximizer (CM) programs in the United States, which prevent manufacturer copay assistance from counting toward deductibles or out-of-pocket (OOP) maximums, are increasingly used, raising concerns about costs and outcomes for patients with major depressive disorder (MDD) or bipolar disorder (BPD) treated with branded atypical antipsychotics (AAPs) and/or antidepressants (ADs). This retrospective claims study used Kythera commercial data (2020–2024) in the United States to identify adults with MDD or BPD who had at least 1 diagnosis and one branded AAP or AD prescription between 2021 and 2023, requiring 12 months’ continuous enrollment pre- (2020–2021) and post-index (2023–2024) and at least three months of post-index branded medication use. This retrospective claims study used Kythera commercial data (2020–2024) to identify adults with MDD or BPD who had at least one diagnosis and one branded AAP or AD prescription between 2021 and 2023, requiring 12 months’ continuous enrollment pre- and post-index and at least 3 months of post-index branded medication use. Patients were stratified into CA, CM, or standard copay plan (SCP) cohorts, and propensity score matching was used to compare treatment patterns and costs. Both CA and CM groups had significantly higher median OOP costs than SCPs (e.g., $75/$60 vs. $16 for MDD+AAP; p < 0.0001), and higher pharmacy costs among adherent patients. CA patients had poorer adherence and persistence, shorter treatment duration, and higher discontinuation and abandonment rates than SCPs. These findings highlight higher OOP burden and adherence challenges with CA and CM programs, underscoring the need for careful benefit design for US mental health patients.