Insurers have begun to roll out Accumulator Adjuster (also called Deductible Reset) benefit designs, in which manufacturers’ coupon buy downs no longer count towards a patient’s deductible or out-of-pocket maximum. The Accumulator Adjuster currently poses the greatest risk to specialty brands, where co-pay support programs help reduce patient costs, especially through deductibles, but in the future may also extend to retail products. In this article, the IQVIA™ US Market Access Strategy Consulting team discusses the impact of Accumulator Adjuster programs on pharmaceutical manufacturers and strategies they can implement to prepare for and mitigate the impact of such programs.