Moving Beyond Mitigation: Cracking the Maximizer Code to Protect Patient Affordability

Today’s guest post comes from Logan Melchione, VP of Patient Affordability at Paysign.

Logan explores how maximizers have reshaped the patient affordability landscape and pressured pharmaceutical manufacturers to adapt their copay strategies. In this guest post, she outlines her perspective on the limitations of traditional copay solutions, describes Paysign’s data-driven approach to first-fill identification of maximizer impact, and shares how the company reports saving millions while improving patient access.

To request an analysis of your program’s maximizer exposure risk and learn more about Paysign solutions, email affordability@paysign.com or visit paysign.com/rx.

Read on for Logan’s insights.

Moving Beyond Mitigation: Cracking the Maximizer Code to Protect Patient Affordability
By Logan Melchione, VP of Patient Affordability, Paysign

The patient affordability landscape is ever changing. With increasingly complex PBM compensation models, payer changes, patient access hurdles, and a growing demand for cost-effective solutions, copay assistance programs have become more critical than ever. But not all copay solutions are built the same. A new wave of innovation is shaking up the status quo—and has real-world results to prove it. In 2024 alone, this new technology helped one disruptor’s clients save over $100 million in copay program costs. So, what’s the secret? First, let’s talk about why the old way is broken.

Where Traditional Providers Drop the Ball
Legacy copay solution providers have become stagnant and entrenched in outdated models that haven't kept pace with the industry’s rapid evolution. Here's where they come up short:

• Limited ways to mitigate accumulators and maximizers: These programs can drain copay assistance dollars fast, but traditional solutions take too long to react.


• Lower strategic priority: When copay is just one of many offerings, development resources are often applied toward other solutions instead.


• Clunky patient experience: Confusing workarounds and friction-filled processes can leave patients with more questions than answers, impacting adherence.

In short, a shake-up was overdue. When the challenges of an entire industry are not being addressed, true innovators apply their experience and expertise toward solving them, rather than merely mitigating.

Maximizer Mastery: A First-Fill Breakthrough
Maximizers and accumulators now affect over 40% of commercially insured patients. That’s a sizeable portion of insured lives—and a major risk to patient affordability.

Older systems couldn’t catch these issues early enough, struggling to identify maximizers on even the second or third fill. But starting in 2022, a revolutionary new approach emerged. Built on real-time dynamic business rules and advanced program architecture, this model didn’t just achieve mitigation—it cracked the code. Tested by early adopters in Top 10 pharma, it was proven to accurately identify and react to maximizer-impacted claims on the very first fill.

By 2024, with widespread adoption across top pharma brands and multiple therapeutic areas, the results spoke volumes: instead of copay dollars being diverted to the benefit of payers and PBMs—funds were helping patients afford their prescribed medications and therapies—as intended.

The Proof Is In: Results That Speak Loud and Clear
Data from over 66 copay programs and 500,000+ unique patients that spanned various drug classes was analyzed to determine the performance and efficacy of dynamic business rules. The technology delivered big results in 2024:

• First-fill identification of maximizer-impacted claims with 97% accuracy


• More than $100 million saved for their clients’ patient affordability programs in 2024 and $84 million saved in Q1 of 2025 alone.


• Increased adoption by Top 10 pharma companies, signaling widespread trust and growing industry integration.


• Accelerated growth, with more manufacturers, program managers, and hubs recognizing the urgent need for smarter solutions that address the challenges of their industry.

The solution is no longer theoretical—it is a proven approach designed for the modern pharmaceutical world and is poised to become an industry standard.

The Future Is Dynamic: A Smarter Copay Approach
A new breed of copay strategy is rewriting the patient affordability playbook. Here’s what sets it apart from legacy models, and what to look for when modernizing copay program design:

• Rapid adaptation: Seek a solution with dynamic systems that evolve in real time to keep pace with industry changes, making it highly versatile and effective.


• Tailored strategies: One-size-fits-all is out, and custom solutions for each client are in, so look for a provider that tailors a solution to your specific needs.


• Controlling fraud and waste: Select a vendor that proactively curtails wasteful spending at fill one—not fill three—and ensures patient access and adherence goals can be met efficiently.

Paysign Has Mastered the Art of Advancement
Copay solutions are entering a new era and Paysign is leading the way with its proprietary dynamic business rules. For pharmaceutical companies, the message is clear: the tools now exist to protect patient affordability dollars from being misappropriated. The goal is no longer mitigation—it’s adopting a proven solution that has mastered maximizers.

For brands navigating the challenges of a fragmented payer environment and increasing scrutiny on program ROI, Paysign offers a proven, transparent, and patient-centric path forward. Request an in-depth analysis of your copay savings programs by emailing us at affordability@paysign.com or visit paysign.com/rx.

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