Pharmacy benefit managers crack down on copay assistance programs
A number of PBMs have put in place policies preventing money contributed via assistance cards from being counted towards a patient’s deductible.
Pharmacy benefit managers are trying to undermine a tactic used by pharmaceutical companies to get patients to buy name-brand drugs.
In an effort to encourage patients to opt for their medications, drug-makers often provide customers with “copay assistance” cards –– essentially debit cards –– that they can use to cover some of the out-of-pocket cost of the prescriptions.
Pharmacy benefit managers and insurers, however, are not fans of the assistance cards because they reduce the incentive for patients to choose lower-cost generic drugs. While the co-pay assistance reduces what the patient pays, it certainly does not reduce what the insurer is paying.
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In recent months, Express Scripts and a number of other pharmacy benefit managers have put in place “copay accumulator” policies so that the money contributed via assistance cards will no longer be counted towards a patient’s deductible. Although that won’t entirely eliminate the appeal of the assistance cards, it will reduce it.
Pharma analysts say that the policies are already having an impact. Real drug prices fell 5.6 percent in the first quarter of 2018.
Sector & Sovereign research analyst Richard Evans tells Reuters that he expects those drops to double or triple next year if pharmaceutical companies can’t find a way to get around the copay accumulator programs. One way that some may do it is by simply providing patients with pre-paid debit cards, making it impossible for pharmacies to distinguish what the patient is paying from what the pharma company is paying.
So far, says Evans, 17 percent of health plans with at least 5,000 members have put in place co-pay accumulator policies. In all likelihood, plans will continue to adopt the policies in an attempt to rein in costs for insurers and employers.
Express Scripts Chief Medical Officer Steve Miller, however, says that the reduction in drug prices has more to do with an increase in competition from generic drug-makers than the measures being taken by pharmacy benefit managers.
In a recent call with investors, AbbVie CEO Richard Gonzalez said that about 4 percent of those who use its arthritis medication, Humira, were on plans with co-pay accumulators. He suggested that that fact has and will reduce revenue, but not disastrously so.