|
 Large U.S. companies have started tightly managing how employees and
their family members use these popular discount, or copay, cards for
everything from multiple sclerosis treatments to widely-used
rheumatoid arthritis medications sold through a specialty pharmacy.
The move reflects their frustration that the coupons, which lower
patient out-of-pocket spending, can be a disincentive to seeking
less expensive treatments and drive up health plan costs.
For certain therapies, the insurance programs extract more money
from the drugmaker or redirect the employee to a cheaper medicine,
according to benefits experts.
Home Depot's program, run by CVS Health, has a particular focus on
therapies for cystic fibrosis, hepatitis C, cancer, HIV, psoriasis,
pulmonary arterial hypertension and hyperlipidemia, or extremely
high cholesterol, according to health plan documents provided to
Reuters.
The company, which has 400,000 employees, said the program affects
fewer than 1 percent of its plan members.
Yet those participants can have an outsized impact on spending
because of how costly it is to treat their conditions.
Specialty drugs can account for more than half of a corporate health
plan's spending on medicines, according to benefits consultant
Mercer.
Employers who use the most comprehensive program at CVS can save up
to 7 percent on their total specialty medication costs, CVS told
Reuters.
Express Scripts Holding Co, the largest U.S. manager of pharmacy
benefits and the manager of Walmart's program, has a similar
broad-reaching program across specialty medications. But it also
offers a more aggressive focus on hepatitis C, oral oncology drugs
and hereditary angioedema treatments.
CONCERNED DRUGMAKERS
The programs, known as copay "accumulators" and copay "maximizers,"
are expected to expand in the next two years, from about 25 percent
of U.S. employers to as much as 50 percent, according to the
National Business Group on Health.
Drugmakers "are concerned about it because the bottom line is that
it will cost them more money,” said Brian Marcotte, the group's
chief executive.
Drugmakers are worried about the hit to profits if many more
employers sign on. They are also concerned because they cannot
easily track when the programs are being used.
Eli Lilly & Co executives said last week that copay accumulator
programs were having an impact on its Taltz psoriasis drug and
Forteo for osteoporosis, but that it did not feel there was
"significant exposure."
Pfizer and AstraZeneca executives said in recent interviews with
Reuters that they are monitoring the effect of these programs.
[to top of second column] |
"The impact on our business is relatively limited, but it is a
concern," said Ruud Dobber, who heads Britain-based AstraZeneca's
U.S. commercial operations.
AbbVie, maker of top-selling arthritis treatment Humira, said in
April it expects moderately higher spending on copay assistance this
year.
BYPASSING THE COPAY
More than 170 million Americans have health coverage through their
employers and pay some portion of their prescription drug costs,
amounting to up to thousands of dollars a year in copayments.
Employers say that keeps workers aware of the rising cost of
medicines and more likely to accept cheaper alternatives, where
possible.
Drugmakers have tried to bypass that requirement to keep patients
using their medicines. They offer discount cards that keep the
patient's payment low, say at $25, when they fill a prescription.
The drugmaker pays the remainder required by the health plan,
thwarting employers' intentions.
Pharmaceutical industry spending on copay cards has more than
doubled to $7 billion over the past five years, mostly due to
coupons offered on higher-cost specialty drugs, according to
consultancy ZS Associates.
The programs at Express Scripts and CVS, which manage prescription
drug benefits for employers, change how this works.
A copay "accumulator" recognizes when an employee uses a drugmaker
discount card and makes sure that money does not apply toward their
annual out-of-pocket spending requirement.
When the copay card runs out of money, a patient must either cover
the full copay cost, get a new discount card, or stop filling the
prescription. The program can apply to almost any drug coupon used
at a pharmacy working with the pharmacy benefit manager.
A copay "maximizer" is more limited in scope, but potentially as
costly to the drugmaker. They apply only to a short list of drugs
that employees purchase from specialty pharmacies run by Express
Scripts and CVS.
In maximizer programs some benefit managers, including Express
Scripts, make sure patients sign up to receive copay cards from the
manufacturers. They then raise the patient's required copayment to
tap the discount cards for the maximum amount set by a drugmaker,
which can be more than $10,000 annually for pricey drugs.
New Jersey-based pharma and managed care consultancy Zitter Health
Insights estimates that there are more than 41 million Americans in
plans that use an accumulator and 9 million in plans with the
maximizer approach. It is not clear how much overlap there is
between the two as some employers use both.
(Reporting by Caroline Humer and Michael Erman; Editing by Michele
Gershberg and Bill Berkrot)
[© 2018 Thomson Reuters. All rights
reserved.] Copyright 2018 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content. |
