New research from the IQVIA Institute for Human Data Science shows that when cost sharing rises, patients are more likely to abandon their medicines. In 2017, 69 percent of commercially insured patients did not fill their new prescriptions when they had to pay more than $250 out of pocket, while only about 11 percent of patients with out-of-pocket costs of less than $30 abandoned their prescriptions at the pharmacy. Compounding this problem is rapidly increasing patient cost sharing for brand medicines, a result of increased use of deductibles and coinsurance in the commercial market.
A previous analysis found that most patients who abandon a prescription do not fill any prescription within three months, suggesting that they are not using a lower cost drug but are instead failing to start treatment as prescribed by their physician.
Patient abandonment and lack of adherence to medicines significantly impact health outcomes, particularly for patients with chronic diseases. In fact, research shows that better use of medicines could eliminate $213 billion in U.S. health care costs annually – eight percent of the nation’s health care costs.
In an effort to help patients stay adherent to medicines while facing growing out-of-pocket costs, biopharmaceutical companies offer commercially insured patients copay coupons for some medicines. These coupons have a measurable impact on patients’ access to their medicines: The IQVIA study showed that for new patients using coupons in 2017, if co-pay cards had not been used, patients would be almost three times as likely to abandon their medicines at the pharmacy.
Unfortunately, copay accumulator programs, instituted by insurers and pharmacy benefit managers (PBMs), block these coupons from being applied to patient’s out-of-pocket maximums and deductibles. As a result, patients can face thousands of dollars in unexpected costs at the pharmacy and, as evidenced by the data, this can lead patients to abandon their prescriptions.
These programs are part of a growing trend where insurers are increasingly asking patients who rely on medicines to pay more out of pocket due to the complex system of list prices, net prices and rebates. System changes to fix broken incentives and make the system work better for patients are needed. This is why the industry recently announced it is advocating for reforms that prevent PBMs and other entities in the supply chain from having their compensation calculated as a percent of the list price of a medicine and instead a fee based on the value their services provide.
To learn more, visit www.LetsTalkAboutCost.org.
Holly Campbell
Holly Campbell is former deputy vice president of public affairs at PhRMA focusing on the cost and value of medicines.
Holly Campbell
Reimagining patient access through meaningful policy reform
New PES survey: Out-of-pocket costs lead key health care priorities ahead of the November election
Don’t put the government between patients and their medicines
The IRA could lead to higher out-of-pocket costs for 3.5 million Medicare patients in 2026
69 percent of patients abandon medicines when cost sharing is more than $250
Drug Cost
Out-of-Pocket Costs
Lets Talk About Cost
69 percent of patients abandon medicines when cost sharing is more than $250
69 percent of patients abandon medicines when cost sharing is more than $250