The Risk of Believing 'Zero Disruption' in Copay Maximizer Mitigation

It’s a bold promise and an appealing one. In a market where biopharmaceutical manufacturers are under pressure to protect patient access while controlling spend, it’s easy to see why such a claim resonates. But brand leaders should take a moment to question whether any solution can truly neutralize PBM maximizer tactics without causing disruption for a single patient. The phrase “zero patient disruption” is memorable and it subtly suggests a level of control that no copay or patient services provider can realistically guarantee. Even the strongest maximizer mitigation strategy will encounter real-world challenges, including:

• Pharmacies that are too busy or otherwise unable to provide assistance
• Insurance plans that redirect responsibility back to the pharmacy
• Pharmacy staff who are new or unfamiliar with maximizer requirements
• Plan design limitations that restrict coverage beyond the maximizer

These operational challenges are not just theoretical. They can have measurable consequences for patients and healthcare providers. At Valeris, our experience in the field aligns with what peer-reviewed research shows. A recent 2025 specialty pharmacy journal article reported that maximizers and related copay adjustment programs add administrative burden, increase the likelihood of benefit investigation errors, and in some cases delay therapy initiation.

These findings reinforce what we see every day in practice. Even carefully designed mitigation strategies must navigate complex operational realities to protect patient access.

At Valeris, our maximizer migration approach is engineered to deliver exceptionally low patient disruption, and we stand behind that. Suggesting “zero disruption” sets brands up with expectations that simply do not reflect real-world patient experience. Framing expectations realistically helps biopharmaceutical manufacturers plan effectively while ensuring patients receive the support they need.

Leveraging years of operational expertise and data-driven strategies, Valeris partners with biopharmaceutical manufacturers to minimize disruption, protect patient access, and deliver meaningful gross-to-net improvements. Our approach focuses on outcomes that are achievable, providing transparency, measurable results, and confidence when navigating complex maximizer programs. With this experience and strategic depth, we also help brands work through challenges in real time, designing solutions that support patients in an unforeseen and ever-evolving landscape, backed by technology built to adapt alongside the market.

Reach out to our team to learn more about our maximizer mitigation philosophy and how we keep patient disruption exceptionally low.