- PhRMA, the powerful trade lobby for the drug industry, is out with a new ad push criticizing insurers and pharmacy benefit managers for changing how they process the copay coupons issued by drugmakers.
- The subject of PhRMA's ire is a practice rolled out by UnitedHealthcare Group Inc. and Express Scripts Holding Co. to no longer credit the value of manufacturers' copay coupons toward patient deductibles.
- By covering the cost of a copay with a coupon, drugmakers can lower patient expenses and thereby reduce the likelihood a prescription gets abandoned at the pharmacy counter. Consumers end up paying less out of pocket but the pharma also sees higher sales.
"Why are middlemen trying to keep you from reaching your deductible?" reads one of the new ads from PhRMA.
It's the latest jab in a battle between the drug industry and payers over who should hold the blame for consumers' rising prescription drug costs. Since last year, PhRMA has run a campaign it dubbed "Let's Talk About Cost," aiming to highlight the role of other players in determining the price consumers pay out of pocket.
In the latest campaign, PhRMA is targeting programs known somewhat opaquely as "co-pay accumulators." In the past, the value of copay coupons have typically been applied toward a patient's deductible or out-of-pocket spending maximum.
This year, however, insurers and PBMs like UnitedHealth and Express Scripts are only counting what a patient actually pays, omitting copay coupons for the purposes of calculating how much patients need to spend to hit their limits.
For payers, copay coupons effectively chip away at revenues and distort how benefit plans are designed. Not all patients need a medication eligible for a copay coupon, for example, and pay their full deductible, while those who are supported by a drugmaker coupon program end up spending less out of pocket then they would have normally.
America's Health Insurance Plans (AHIP), a trade lobby for commercial payers, published a blog post Tuesday pushing back on the pharma industry's efforts to paint insurers in a negative light.
"The original list price of a drug drives the entire pricing process, and that price is determined and controlled 100 percent by the drug company," AHIP chief operating officer Matt Eyles wrote in the post.
PhRMA, however, sees it differently.
"Copay accumulator programs are nothing more than an insurance scheme that leave patients financially exposed while benefiting payers’ bottom lines," said PhRMA CEO Stephen Ubl in a March 27 statement.
Without copay coupons counting toward deductibles, patients could end up facing higher costs than they have in the past — a potential spark for more outrage over drug costs that the drug industry has no interest in shouldering the blame for.
PhRMA said the ads will run in print, radio, TV and digital channels across D.C. and other unspecified states.
Editor's note: This article has been updated to include reference to AHIP's March 27 statement.