Patient (or “copay”) assistance programs and coupons present a bit of a double-edged sword. While they help facilitate payment for certain drugs, they also complicate the payment process immensely. Both help patients ultimately gain access to expensive drugs that otherwise may not be affordable. However, the intention behind each approach differs considerably, as does the overall impact.
Run by pharmaceutical manufacturers, were originally designed to help remove cost as a barrier to care. Predominantly income-based, these programs required patient application and manufacturer approval. As of late, fewer and fewer of these programs are using income-based criteria. About 80% of specialty pharmacies now offer some type of patient assistance program.1
Also help with the affordability of expensive drugs and are growing increasingly popular. They are made available for certain brand and specialty drugs at the doctor’s office and online to offset the employee cost share under benefit plans. According to IMS Health, by 2012, coupons were available for 395 indications – a dramatic jump from only 86 indications in 2009.2 While widely enjoyed by patients, this consumer resource has been problematic for employers with a tiered benefit design. In some cases, a coupon is used to pay for a brand drug in a class with many generic options, undermining the strategies designed by employers to keep costs down. A 2013 analysis found that 62% of coupons studied were tied to branded drugs for which lower cost alternatives existed.3 Research done by the Pharmaceutical Care Management Association (PCMA) in 2011 revealed that copay coupons could amplify 10-year prescription drug costs by $32 billion for employers, unions and other plan sponsors.4 In other cases, however, coupons are offered alongside brand new medications for which there are no available alternatives. The Business Group’s Pharmacy Committee has categorized and referred to these as “bad coupons” and “good coupons,” respectively.
Helping to defray the costs of drugs for employees is a worthwhile goal, but it is important that cost-cutting measures be managed appropriately so that they don’t disrupt plan design. Business Group members can explore management tips here.