Each year, middlemen, like pharmacy benefit managers (PBMs) and insurers, shift more of the costs of health care to patients. Ensuring patients have affordable access to their medicines is the top priority for the biopharmaceutical industry. We need to make sure insurance benefits encourage and promote health – not prevent patients from accessing health care treatments. Copay coupons offered by biopharmaceutical companies can provide a valuable source of assistance for many commercially insured patients to afford out-of-pocket costs associated with insurance coverage for their medicines.
Since 2006, deductibles have increased 300 percent. There has also been an 89 percent rise in what patients pay in coinsurance, which is a percentage of costs associated with their health care service or medicine. This has left patients with high and often unpredictable costs for their medicines. A recent analysis from Amundsen Consulting found more than half of commercially insured patients’ out-of-pocket spending for brand medicines is for medicines filled while a patient is in the deductible or has coinsurance.
Even though rebates paid by biopharmaceutical companies often substantially reduce what insurers and PBMs pay for medicines, insurers typically use list prices—rather than discounted prices—to determine how much to charge patients with deductibles and coinsurance. Unlike care received at an in-network hospital or physician’s office, negotiated discounts for medicines are usually not shared with patients with high deductibles or coinsurance. Sharing rebates with patients at the pharmacy could save certain commercially insured patients with high deductibles and coinsurance $145 to more than $800 annually, according to a recent analysis from Milliman. Because these discounts are not being passed on, biopharmaceutical companies directly help patients by offering copay coupons to lower what patients pay at the pharmacy.
Even as many patients depend on these copay coupons, some have argued coupons drive up costs by encouraging patients to take brand medicines when they could take a generic. Contradicting these claims is new research from IQVIA, which shows just 0.4 percent of commercial medicine claims were filled with a coupon for a brand medicine with a generic alternative. This is no surprise since PBMs have many tools to discourage the use of brand medicines when there are generics. For example, PBMs can exclude the brand medicine from the formulary or subject it to prior authorization or step therapy.
The research from Amundsen Consulting also revealed patients are more than twice as likely to abandon brand medicines filled in the deductible than those not filled in the deductible. And a recent Federal Reserve study found that 44 percent of Americans would have trouble paying an unexpected $400 emergency expense and would need to borrow or sell something to come up with the money. Without these copay coupons, many patients would not be able to afford their medicines and would leave the pharmacy empty-handed.