Pharmaceutical companies have cut financial assistance to thwart health-plan tactics
It looks to me like the insurance companies want to make patients pay some share (co-pay) of drugs to give them an incentive to go with lower price options. But the drug companies would rather sell high price drugs. So they tell patients that they will pay their co-pay if they go with the higher price drug. But then the insurance companies have to spend more on drugs so they try to thwart what the drug companies are doing to limit how many high price drugs their patients select.
"Health insurers and employers who pay for healthcare have long tried to make patients pay a portion of the price of expensive medicines, in part to encourage patients to take cheaper, equally effective treatments.
The efforts often take the form of copays, which patients have to pay each month before they can fill a prescription. Growing numbers of people with insurance must also pay a sum, called a deductible, at the start of each year before their health plan will start reimbursing for drugs.
To counter the health plans, drugmakers created financial-assistance programs that cover all or most of patients’ out-of-pocket costs. The programs, by taking care of the out-of-pocket expenses, cleared the way for health plans to pay for the rest of a drug’s cost.
Some health plans, seeking to restrain rising spending on higher-priced drugs, in turn took steps to counter the pharmaceutical assistance programs. For example, they stopped counting drugmakers’ assistance toward deductibles, or they required a member to seek the maximum amount of aid available before an insurer would pay the rest of the drug’s cost.
Plans also designed benefits to steer some members to pharmaceutical company foundations that give away free drugs to people meeting certain income requirements, and who don’t have insurance or whose health plan doesn’t cover specific drugs.
Companies sprouted up to advise employers on how to save money by taking advantage of the pharmaceutical assistance programs. These middlemen, which market themselves as advocates or chaperones to “alternate funding programs,” are paid by employers, often based on a percentage of the savings they provide.
The cost of the pharmaceutical companies’ financial-assistance programs ballooned. Drugmakers spent $18.7 billion on copay assistance in 2022, up 29% from $14.5 billion in 2018"
"On Jan. 1, a nonprofit established by J&J to provide free medicines began excluding all patients who have health insurance. The company, which sells the psoriasis drug Stelara and blood thinner Xarelto, created a new, in-house program to provide free medicine to some insured patients, but not those whose plans require them to seek free medicine."
"Pfizer on Jan. 1 began excluding new patients with commercial insurance from its free-medicine program. The company also dropped certain off-patent drugs from its free-medicine program because alternatives or generics are available, a move that affected about 24% of patients"
Related posts:
Obscure Model Puts a Price on Good Health—and Drives Down Drug Costs (2020)
Pharmacy-benefit managers and drug prices (2023)
No comments:
Post a Comment