Socioeconomic Disparities in Access to Treatment for Major Depressive Disorder: The Role of Accumulator and Maximizer Insurance Plans
Author(s)
Onur Baser, MS, PhD1, Katarzyna Rodchenko, MA, MPH2, Lixuan Wu, MS2, Nehir Yapar, BS2.
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA.
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA.
OBJECTIVES: Copay accumulator (CA) and Copay maximizer (CM) programs prevent patient assistance programs from counting toward deductibles or out-of-pocket (OOP) maximums, inflating cost-sharing obligations for prescribed treatments. To examine how health insurance benefit designs (accumulator and maximizer plans) exacerbate treatment abandonment among patients with major depressive disorder (MDD) in lower vs higher socioeconomic status (SES) areas and evaluate implications for health equity.
METHODS: This retrospective claims study used Kythera Labs commercial data (2020-2024) to identify adults with MDD who had ≥1 diagnosis and 1 branded AAP or AD prescription between 2021 and 2023, requiring 12 months’ continuous enrollment pre- and post-index and ≥3 months of post-index branded medication use and compared treatment abandonment rates in CA/CM plans vs standard copay plans, stratified by SES. Multinomial logistic regression models controlled for demographics and proxy measures for clinical severity.
RESULTS: Of the study population, 1,753 patients were enrolled in accumulator or maximizer (A/M) health plans, and 8,997 patients participated in standard copay plans. Patients in the A/M group were generally younger, more likely to be female, and had lower comorbidity index scores vs those in standard copay plans. After adjusting for demographic and clinical differences, lower-SES patients with MDD in A/M plans were found to be 1.5 times more likely to abandon their treatment vs higher-SES patients with the same plan type (p<0.001). When compared to patients in standard copay plans, those in A/M plans had a 37% higher likelihood of treatment abandonment, even after controlling for confounding factors (p<0.001).
CONCLUSIONS: Accumulator and maximizer plans intensify health inequities by inflating OOP costs for vulnerable patients with MDD, forcing treatment abandonment. Reforming benefit design such as value-based insurance models that reduce cost-sharing for high-value mental health services, is critical to advance health equity and ensuring access for marginalized populations.
METHODS: This retrospective claims study used Kythera Labs commercial data (2020-2024) to identify adults with MDD who had ≥1 diagnosis and 1 branded AAP or AD prescription between 2021 and 2023, requiring 12 months’ continuous enrollment pre- and post-index and ≥3 months of post-index branded medication use and compared treatment abandonment rates in CA/CM plans vs standard copay plans, stratified by SES. Multinomial logistic regression models controlled for demographics and proxy measures for clinical severity.
RESULTS: Of the study population, 1,753 patients were enrolled in accumulator or maximizer (A/M) health plans, and 8,997 patients participated in standard copay plans. Patients in the A/M group were generally younger, more likely to be female, and had lower comorbidity index scores vs those in standard copay plans. After adjusting for demographic and clinical differences, lower-SES patients with MDD in A/M plans were found to be 1.5 times more likely to abandon their treatment vs higher-SES patients with the same plan type (p<0.001). When compared to patients in standard copay plans, those in A/M plans had a 37% higher likelihood of treatment abandonment, even after controlling for confounding factors (p<0.001).
CONCLUSIONS: Accumulator and maximizer plans intensify health inequities by inflating OOP costs for vulnerable patients with MDD, forcing treatment abandonment. Reforming benefit design such as value-based insurance models that reduce cost-sharing for high-value mental health services, is critical to advance health equity and ensuring access for marginalized populations.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR186
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Patient-Centered Research
Topic Subcategory
Health Disparities & Equity, Insurance Systems & National Health Care
Disease
Mental Health (including addition), No Additional Disease & Conditions/Specialized Treatment Areas