Disclaimer: The views and opinions expressed in this article are these of the writer and do not reflect the official coverage or position of Pharmacy Times.
A current article in the new York Times entitled “Drug Coupons: Helping a number of at the Expense of Everyone” painted a reasonably grim and greedy image of the drug manufacturing industry, and instructed that coupons “may be making drug prices increased for everybody.”1 As a pharmacist regularly involved in using these coupons and interacting with physicians and patients about them, I’d wish to recommend a extra balanced perspective that doesn’t seem to have been sufficiently appreciated by the author of the article.
Drug coupons are producer programs that allow pharmacies to invoice the copay portion (ie, what the patient must pay) to the drug producer who absorbs all or most of that copay, allowing the patient a much more inexpensive monthly expense. Additionally, these coupons are sometimes used to cover your complete cost of the remedy the first time it’s crammed, allowing the patient a digital “free trial” of the product, typically entirely at the expense of the manufacturer.
The article rightly pointed out that such practices encourage patients to make use of and keep on dearer medications, relatively than attempting cheaper alternatives. The extra price of those medications then becomes the burden of the health plan or pharmacy benefit manager (PBM), which in flip will, of course, must unfold out such prices over your entire plan membership within the type of upper premiums. All of that is true.
But what the article appears to disregard is that the PBM or well being plan clearly has a profit-incentive to steer patients and their prescribers to the lowest value product available. These copay cards don’t routinely enhance costs for everyone. They eat into the income of the PBM throughout the current 12 months (premiums have already been set for this 12 months) and should then result in premium increases in the following yr. However, if one is taking a look at current earnings reviews and earnings by some of the highest well being plans, one is hardly inclined to portray them as suffering by the hands of those copay cards.
In an article by Wendell Potter final 12 months, he points out the very comfortable income being enjoyed by the medical insurance industry within the United States: “Let’s be clear, these insurers aren’t suffering. UnitedHealth Group, the largest health insurer, reported last week that it made $10.Three billion in earnings in 2014 on revenues of $130.5 billion. Both earnings and revenues grew 7% from 2013.”2
It’s merely a enterprise determination to pass along higher premiums to employers and patients somewhat than taking a hit to the revenue line, when patients are allowed to use dearer, and often more effective, medications.
Not only that, but the article fails to say that PBMs have already engaged in powerful negotiating practices to help scale back their price-burden via the use of discounts and rebates. Do shoppers instantly profit from these rebates? They don’t. It’s as if the author of the article is enthusiastic about protecting the health business from eroding earnings greater than the consumer from extreme copays.
And what concerning the prior authorization process that’s usually imposed on these dearer drugs by the well being plan? When the drug’s lastly approved, which means that the health plan and supplier are both agreed that it’s acceptable, why shouldn’t the manufacturer assist the patient with a lowered copay? In such situations, the higher copay may actually be steering patients away from probably the most acceptable and medically necessary therapy.
Copay reduction coupons also improve adherence to therapy by making the medicine more affordable, sometimes even cheaper than a generic. The result of higher adherence is typically better outcomes, which could possibly be argued as a way to decrease the overall cost of health care.
I agree with the Massachusetts ban on copay cards for products which have an FDA-permitted generic. Although there’s sure to be a small subset of patients who really feel the generic isn't applicable for them, this small fraction of patients shouldn’t be allowed to drive up costs when all the medical evidence points to the equivalence of those merchandise.
But when the clinical evidence helps the use of a drug equivalent to ticagrelor (Brilinta) over the dangerous and burdensome use of a drug comparable to warfarin (requiring frequent blood work), then I see no purpose why the producer should be forbidden from helping the patient with a lowered copay.
This is clearly a difficult subject. Subsidizing patient copays through the use of coupon cards does impact the tier and formulary strategy of the health plan. However it may also be seen as a protection for the patient in opposition to unaffordable copays and deductibles, which could put mandatory and useful medications out of their monetary attain. Although I don’t assume copay playing cards are an answer to the rising prices of health care, I also don’t assume they’re the great enemy they are generally reported to be.
References 1. Sanger-Katz M. Drug coupons: helping a few on the expense of everyone. New York Times website. October 12, 2016. nytimes.com/2016/10/13/upshot/drug-coupons-serving to-a-few-at-the-expense-of-everybody.html?_r=0. 2. Potter W. prescription coupons watch profits soar as they dump small enterprise clients. The middle for Public Integrity website. January 26, 2015.
|