WASHINGTON, D.C. (March 27, 2018) — The Pharmaceutical Research and Manufacturers of America (PhRMA) today unveiled new advertisements as part of its “Let’s Talk About Cost” campaign highlighting how the use of copay accumulator programs by insurance companies and other middlemen could result in patients facing thousands of dollars in unexpected medical costs. These programs, where applied, block the copay coupons biopharmaceutical companies offer for some medicines from being applied to deductibles and out-of-pocket maximums, which over the course of the year leads to patients paying significantly more at the pharmacy.
In recent years, pharmacy benefit managers (PBMs) and insurers have been increasingly shifting more health care costs to patients. According to data from the Kaiser Family Foundation, since 2006, deductibles have increased 300 percent and there has been an 89 percent rise in what patients pay in coinsurance, which is a percentage of costs associated with their health care service or medicine.
“Copay coupon programs offered by biopharmaceutical companies provide a valuable source of assistance for many commercially insured patients who are facing rising out-of-pocket costs because of deteriorating insurance coverage for medicines,” said Stephen J. Ubl, president and chief executive officer of PhRMA, citing a report from last year which found that brand prescriptions subject to a deductible are more than twice as likely to be abandoned at the pharmacy than those not subject to a deductible.
In 2018, many insurers and PBMs implemented copay accumulator programs changing how copay assistance for some medicines applies to patient cost sharing. When this tactic is applied, copay assistance does not count toward a patient’s deductible or out-of-pocket maximum. Often patients are not aware these programs were added to their insurance coverage and find out only after they thought they reached their deductible that the copay assistance no longer counts toward this amount – leaving them with potentially thousands of dollars of unexpected medical costs.
Insurance companies and middlemen are marketing copay accumulator programs in a misleading way to suggest they will provide greater cost protection for patients when the reality is the opposite. For example, UnitedHealthcare calls their program “Coupon Adjustment: Benefit Plan Protection program”, and Express Scripts calls theirs an “Out of Pocket Protection” program. Yet both programs may result in patients paying far more out of pocket.
“Copay accumulator programs are nothing more than an insurance scheme that leave patients financially exposed while benefiting payers’ bottom lines,” continued Ubl.
The new ads will be featured in print, radio, digital and social channels in Washington, D.C., and select states. The first print ad asks, “Why are middlemen trying to keep you from reaching your deductible?”, and highlights how these programs could result in patients paying thousands of dollars more at the pharmacy counter. It concludes, “Your medicine should work for you. You shouldn’t have to work for your medicine.”
To view the advertisements, visit LetsTalkAboutCost.org/coupons.
The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading innovative biopharmaceutical research companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier and more productive lives. Since 2000, PhRMA member companies have invested more than half a trillion dollars in the search for new treatments and cures, including an estimated $65.5 billion in 2016 alone.