April 16, 2018
The
Pharmaceutical Research and Manufacturers of America (PhRMA)’s recent ad
campaign takes aim at so-called copay accumulator programs, whereas America’s
Health Insurance Plans (AHIP) contends that drug manufacturers’ copay coupons
are the bigger problem.
Under
copay accumulator programs, payers prevent the dollar value of manufacturers’
coupons from applying to patients’ deductibles, instead only counting payments
made by the members themselves. Last year almost all drug plans counted copay
coupons toward deductibles, “which really reduced patients’ out-of-pocket
costs,” says Joe Paduda at Health Strategy Associates, LLC.
In
its campaign ads, PhRMA tells consumers that copay accumulator programs could
result in patients paying thousands of dollars more at the pharmacy counter.
Yet
Daniel Nam, executive director of federal programs at AHIP, tells AIS Health
that the federal government treats copay coupons as a direct kickback, “meaning
that the pharmaceutical company is giving something of value to the patient or
whoever in order to increase utilization of their own product.”
He is
also concerned that copay coupons can lead patients to make the wrong choices.
“At the end of the day, it’s all about [drug manufacturers] increasing their
own profit at the expense of everyone around them,” he says.
Caroline
Pearson at Avalere suggests that copay cards are boosting adherence and
utilization, but she questions whether the utilization is appropriate. In
addition, there is little transparency as to who is using the coupons, for what
and for how much.
Ultimately,
some industry experts say the high list price of drugs is the real problem.
“These accumulators and copay coupons are meant to address the really high cost
of specialty meds and some other prescriptions,” according to Paduda. “Pharma
has been jacking up prices at a record pace, to the point where many of these
drugs are unaffordable without some sort of financial chicanery.”
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