The company would not say how it responds when a patient is affected by an accumulator, adding the information was proprietary.ĪbbVie in April said that about 4 percent of patients taking rival arthritis drug Humira were exposed to accumulators, but that they had no material effect on company profits.īelgium’s UCB, which makes a competing drug called Cimzia, said in February that it was reaching out to patients affected by the programs to help them stay on the medication. drug prices, including discounts and rebates, fell 5.6 percent in the first quarter of this year, mostly due to copay accumulator programs, according to Sector and Sovereign Research.Īmgen has said that it altered copay assistance cards for arthritis drug Enbrel to work only if the funds are applied to a patient’s deductible. Another 18 percent of respondents are considering using one next year or in 2020. A survey by the National Business Group on Health (NBGH), which represents large corporate employers, showed that 17 percent of respondents said they were currently using a copay accumulator program. Larger drugmakers may have the financial flexibility to monitor how these accumulator programs affect revenue over time, while those reliant on a small number of drugs may not be able to wait it out, Turner said.ĭrugmakers are also taking a tougher stance when negotiating prices or new discounts for payers, according to insurance industry executives and pharmaceutical consultants. He would not provide details of how those arrangements work. They include new payment options to evade detection by the pharmacy benefits managers (PBMs) so that a patient still benefits from the financial aid, said Matthew Turner, who is working with drugmakers as director of patient affordability at TrialCard, which operates copay cards for companies. PHARMA FIGHTS BACKĭrugmakers are working on ways to counter copay accumulator programs, fearing that more employer health plans will adopt them in 2019. Otherwise the patient could move to an equivalent drug if one is available or abandon their prescription because it is too expensive. These tactics could force the drugmaker to keep paying the out of pocket costs.
Some more aggressive accumulator programs will also draw more money than a drugmaker expected to pay off a copay card when the card is detected. When the deductible is reached, the insurance begins to pay.īut if the insurance plan is using an accumulator, the patient could still have to pay the $2,000 out of pocket when their copay card expires or runs out of money. A copay card from the drugmaker would cover most, or all, of those costs for the patient and it would count towards the deductible. The programs prevent copay card funds from counting toward a patient’s required out-of-pocket spending before insurance kicks in on expensive specialty drugs, such as arthritis and HIV treatments.Īs an example, a patient whose medicine costs $1,000 per month might be required to pay that amount until they reach a deductible of $2,000 set by their insurer. This year, Express Scripts and others introduced a new “copay accumulator” approach for its corporate customers.
employers, say these payments shield consumers from drug costs, making it easier for manufacturers to raise those prices. Drugmakers responded by dramatically raising the financial aid they offer, in the form of “copay assistance” cards - similar to a debit card - that reduce what consumers need to pay when they place their pharmacy order.Įxpress Scripts Holding Co and CVS Health, which manage prescription drug coverage for large U.S. In recent years, insurers have tried to guide patients toward less expensive treatments by making them pay a higher portion of a drug’s costs. Among major drugmakers, AbbVie Inc and Amgen Inc have said the most so far about the new tactic, and more drugmakers will likely face questions about it during quarterly earnings calls in July. That reality is forcing drugmakers to devise their own response in the near term, according to interviews with pharmaceutical and insurance industry executives and consultants. drug prices this year, and is expected to become more widely adopted in 2019. The latest move by insurers - which effectively forces drug companies to pay more to assist patients with their copays - is causing a decline in real U.S. FILE PHOTO: A senior citizen sorts her daily medical prescriptions at her independent living apartment in Silver Spring, Maryland, U.S., April 11, 2012.
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