JustCare

Tag: Coupons

  • Insurers drive up costs for people with diabetes

    Insurers drive up costs for people with diabetes

    The Hill has an opinion piece on a new way that insurers are increasing their profits. Insurers drive up costs for people with diabetes, making it harder for them to get needed care. Instead of applying drug copay coupons toward people’s deductibles, insurers make them pay their deductibles out of pocket.

    Insurers would rather steer clear of patients with diabetes, because they use a significant amount of health care. So, insurers are imposing an additional financial obstacle for them to get care. They are taking advantage of the fact pharmaceutical companies offer people with diabetes drug copay coupons; and, they are effectively appropriating the value of those coupons for themselves. Insurers now require patients to pay their deductibles in full out of pocket rather than allowing them to use their drug copay coupons toward their deductibles.

    Insurers have a series of crazy names for this new policy: “Copay Accumulators,” “Out-of-Pocket Protection Programs” or “Coupon Adjustment: Benefit Plan Protection Programs.” Whatever insurers name the policy, it means that people with diabetes and other costly conditions who benefit from drug company coupons that help with their cost-sharing have to pay their full deductible out of pocket before their care is covered.

    In a more just health care system, people with diabetes would not have to worry about the cost of their insulin or about meeting a deductible. And pharmaceutical companies would be required to charge fair prices for their insulin. They would not be able to hand out discount coupons that end up benefiting themselves and insurance companies more than patients.

    There are now 30.3 million adults in the US with diabetes. And, they are increasingly struggling to get needed care. Over the last 15 years, costs for insulin have more than tripled. Moreover, pharmacy benefit managers (PBMs) are no longer covering many medications and supplies that people with diabetes need. (Another 84.1 million adults have pre-diabetes, a condition which, if left untreated, tends to lead to type 2 diabetes within five years.)

    There are insulins, including NPH, which are far less expensive than the newer insulins. NPH is available without a prescription for less than $30 a vial at some pharmacies. NPH works, but it is harder to manage blood sugar with NPH than it is with more expensive insulins—Humalog or Lantus.

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  • Drug coupons drive up overall health costs

    Drug coupons drive up overall health costs

    Pharma has many tools for generating big profits. Drug coupons, which cover the copay of a high-cost drug, are one such tool. For patients, drug coupons can make extremely high-cost drugs free. But drug coupons drive up overall health costs; they also may incent people to take drugs with unknown risks when other safe drugs are available.

    Drug coupons can seem very attractive to patients. Coupons can make the out-of-pocket cost for a very high-priced drug lower than the patient’s cost for a low-cost drug. Patients need to keep in mind though that drug coupons tend to be for drugs that are new or relatively new to market. And, unless you’re in a situation where no other drug works for you, you should try to avoid taking newly approved drugs.

    Newer drugs can cause serious side effects about which the doctor is unaware, since it’s hard to evaluate a drug’s potential for harm until it has been on the market for several years. That’s why, to be safe, it’s wise to take drugs that have been used for a long time, where the risks of harm are well understood.

    Drug coupons are not only geared to get patients to take expensive drugs that have not been well-tested; they effectively undermine the value of a tiered copay system for drugs.  The tiered copay system is designed to help keep insurance premiums down. It steers people to the lowest-priced drug in a category because it comes with the lowest copay.

    When the doctor gives a patient a coupon for a drug in the highest copay tier, the tier becomes meaningless as the patient is not responsible for the copay. Pharmaceutical companies use coupons to keep patients away from competitor lower-cost drugs. Since the coupon covers the cost of the copay only, the drug companies still get paid a lot for the high-cost drug.

    Federal health care programs forbid the use of drug coupons under the “anti-kickback statute.” So, Medicare does not allow them. But, the Government Accountability Office has found that pharmaceutical companies don’t always have systems in place to prevent the use of drug coupons by people with Medicare and that six percent of people with Medicare do use them.

    Why do doctors prescribe a tier three drug when a lower-cost drug is available to treat a condition? In many cases, the doctors don’t know the price of the drug.  In other cases, a pharmaceutical company has persuaded doctors that its drug is better than other drugs.  Or, patients may ask for the drug because they’ve seen ads for it on TV.

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