Co-pay Coupon Scare Underscores Access Challenges

by Amanda Conschafter, Blog Editor

UnitedHealthcare patients received welcome news this past week: the insurance provider has retracted its proposal to stop accepting co-pay assistance coupons.  Patient advocates argue that coupons, offered by pharmaceutical companies to reduce the co-pay burden, allow for treatment based upon patients’ best interest, not their household budget.  But while the policy reversal marks a victory for patients, the incident highlights ongoing challenges for those who need advanced specialty medications.

The issue of co-pay assistance is both complicated and contentious. The practice, using manufacturer coupons to defray prescription medication co-pay costs, emerged as both unemployment and medication costs rose in recent years. Though coupons can discount prices significantly, UnitedHealthcare contends that they actually increase overall costs. Without the coupons, UnitedHealthcare and likeminded opponents argue, patients will opt for less expensive, generic prescriptions – lowering costs for insurers while receiving comparable treatment.  But patients who thrive on brand-name treatments may not want to risk compromising their progress for cost savings.

Anti-kickback regulations further complicate the issue. Medicare patients are ineligible for co-pay assistance, and now varying interpretations of federal policy have pharmaceutical companies confused about whether patients insured under the Affordable Care Act are also ineligible.  In light of the uncertainty, several companies have opted to forego discounts for patients using the federal health care exchange.

But one fact is clear – losing co-pay coupons would raise monthly medication prices for many patients.  And research suggests that high co-pays could be bad news for patient health.  Studies find that the higher the co-pay, the less likely patients are to follow their doctors’ orders, take their medication as prescribed and refill their medication when they run out.

UnitedHealthcare’s policy retraction eliminates these concerns for patients using co-pay coupons – for now.  But the insurer continues to reject co-pay coupons for Tier 3 medications and seems poised to continue steering patients toward the least expensive treatment option available.  Such efforts may take the shape of fail-first policies or expanded use of specialty tiers, but they have a single effect – guiding patients’ choices based upon price, regardless of patients’ condition and physicians’ prescribed therapy.


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