Featured in AIS Health Daily, April 16, 2018

Insurers, Pharma Split on Copay Coupon Accumulator Programs

A longer version of this article was published in the April 13, 2018, issue of RADAR on Drug Benefits. Subscribe today for biweekly business strategies and analysis for health plans, employers, PBMs and pharma companies.

April 16, 2018

The Pharmaceutical Research and Manufacturers of America (PhRMA)’s recent ad campaign takes aim at so-called copay accumulator programs, whereas America’s Health Insurance Plans (AHIP) contends that drug manufacturers’ copay coupons are the bigger problem.

Under copay accumulator programs, payers prevent the dollar value of manufacturers’ coupons from applying to patients’ deductibles, instead only counting payments made by the members themselves. Last year almost all drug plans counted copay coupons toward deductibles, “which really reduced patients’ out-of-pocket costs,” says Joe Paduda at Health Strategy Associates, LLC.

In its campaign ads, PhRMA tells consumers that copay accumulator programs could result in patients paying thousands of dollars more at the pharmacy counter.

Yet Daniel Nam, executive director of federal programs at AHIP, tells AIS Health that the federal government treats copay coupons as a direct kickback, “meaning that the pharmaceutical company is giving something of value to the patient or whoever in order to increase utilization of their own product.”

He is also concerned that copay coupons can lead patients to make the wrong choices. “At the end of the day, it’s all about [drug manufacturers] increasing their own profit at the expense of everyone around them,” he says.

Caroline Pearson at Avalere suggests that copay cards are boosting adherence and utilization, but she questions whether the utilization is appropriate. In addition, there is little transparency as to who is using the coupons, for what and for how much.

Ultimately, some industry experts say the high list price of drugs is the real problem. “These accumulators and copay coupons are meant to address the really high cost of specialty meds and some other prescriptions,” according to Paduda. “Pharma has been jacking up prices at a record pace, to the point where many of these drugs are unaffordable without some sort of financial chicanery.”


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