New rules some insurance companies are introducing could slam patients with unexpected bills for prescription medicines.
Traditionally, drug manufacturers have subsidized the cost of many expensive medicines through copayment offset programs or coupons. The manufacturer covers the patient’s copayments, which count toward the patient’s deductibles and out-of-pocket maximum amount. The insurance company pays the rest.
But this year, some insurance companies are introducing new accumulator plans that don’t let the manufacturers’ payments cover patients’ deductibles. Proponents say the change will lower overall drug costs because patients will buy cheaper substitutes, saving the insurance companies money.
But many drugs don’t have a cheaper substitute. Out of America’s top 200 drugs (by spending) in 2014, 90 came with copay coupons, according to a study by the University of Southern California’s Schaeffer Center. Out of these 90 drugs, 51 percent didn’t have a generic substitute.
Patients who don’t have a cheaper option either have to pay thousands of dollars up to their plan maximum or go without medicine. And those who go without could have medical emergencies because they aren’t getting the treatment they need.
Insurance companies blame drug makers for inflating drug prices and then subsidizing them with copay coupons. And they say the unfair system means that some patients have to pay their deductibles when others don’t. Steve Miller, the chief medical officer for the Express Scripts plan provider, called on drug manufacturers to lower the cost of drugs in a blog post. “We believe all patients should have access to affordable prescriptions and care, not just those using a medication with drug maker copay assistance,” he wrote. “To that end, lowering the cost of drugs to increase access is the best thing pharmaceutical manufacturers can do.”
But drug manufacturers blame insurance companies for ignoring the needs of patients. “Copay accumulator programs are nothing more than an insurance scheme that leaves patients financially exposed while benefiting payers’ bottom lines,” said Stephen J. Ubi of the Pharmaceutical Research and Manufacturers of America (PhRMA) in a March 2018 statement. —Aspen Daniels