Automating Accumulation & Maximization

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Maximize the value of manufacturer copay programs while maintaining benefit integrity

Over 80% of specialty drug claims involve copay assistance — yet most plans lose control of how it's applied.

Automated Accumulation & Maximization

Our solutions ensure that manufacturer copay assistance is managed intelligently. Accumulator programs prevent copay cards from contributing to deductibles or out-of-pocket maximums, while Maximizer strategies distribute assistance evenly across the benefit year.

Take control of your pharmacy benefit spend and improve member outcomes with automated, compliant, and scalable accumulation and maximization programs.

  • 1
    Control Pharmacy Benefit Spend

    Prevent manufacturer copay assistance from artificially lowering patient deductibles, helping plans maintain financial integrity and reduce unexpected costs.

  • 2
    Extend Patient Support Throughout the Year

    Distribute copay assistance evenly across prescription fills, ensuring patients receive ongoing financial support and avoid gaps in medication adherence.

  • 3
    Improve Member Outcomes

    By managing copay assistance strategically, patients experience fewer financial surprises, better medication adherence, and improved overall health results.

How it Works

workflow diagram showing accumulation and maximization process

Our Automated Accumulation & Maximization solution helps payers and pharmacy benefit managers control how manufacturer copay assistance impacts patient deductibles and out-of-pocket costs.

By combining accumulator adjustment and copay maximizer programs, we ensure financial integrity for plans while extending meaningful support for patients throughout their treatment journey.

Key Process Highlights

The system automatically tracks manufacturer copay assistance on each prescription claim. It then adjusts benefit calculations and payment applications according to your plan’s rules for accumulation and maximization.

Step-by-step workflow:

  • 1. Claim Submission: Patient presents prescription; claim includes manufacturer copay assistance details.
  • 2. Accumulation Adjustment: Copay assistance amounts are excluded from deductible/out-of-pocket accumulation as per accumulator program.
  • 3. Maximization Distribution: Copay assistance value is allocated across multiple fills to extend patient benefit through the year.
  • 4. Real-Time Benefit Impact: Patient pays the correct copay amount, and plan financials reflect accurate cost-sharing.
  • 5. Reporting & Compliance: Detailed analytics provide transparency and support program compliance and optimization.
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