What good is my health insurance if my copays and deductibles are so high that it doesn’t offer me any financial protection?
That’s the question an increasing number of patients are asking as these costs continue to rise. According to data from the Kaiser Family Foundation, deductibles have risen by 300 percent since 2006 and coinsurance costs have nearly doubled. The CDC reports that 40 percent of privately insured Americans now have high-deductible plans, compared with one-quarter who had such plans in 2011.
As if perpetually rising copays and deductibles weren’t bad enough, this year major insurers began coming after copay coupons, widely used assistance to help patients cover their prescription drug costs. Legislators and patients across the country must stand up for this popular program that increases prescription drug accessibility.
Copay coupons are an aid that drug manufacturers provide directly to patients to help them cover their copay costs, which can easily reach hundreds of dollars per prescription. According to research from Stanford University, over half of Rheumatoid Arthritis and over one-quarter of Multiple Sclerosis prescriptions are purchased with the help of copay coupons. The health care consultancy IMSQuintiles estimates that 19 percent of total prescriptions were filled using copay coupons in 2016, nearly 50 percent more than in 2013. Drug manufacturers spend billions of dollars each year on these assistance programs.
This copay assistance provides users with a double benefit. First, and most obviously, it helps those who otherwise could not afford their medications because of copay costs. A new study in the journal Oncology finds that nearly half of patients abandon their prescriptions when their out of pocket costs reach more than $2,000, suggesting programs that help patients cover these costs save lives and livelihoods.
Second, copay coupons help patients more easily reach their annual deductibles and out of pocket maximums. Reaching these thresholds is cause for celebration for patients on fixed incomes because insurance picks up the vast majority of additional costs once they are reached. This allows household budgets to be smoothed, without having to adjust for high deductible costs at a certain time in the year.
In a misguided attempt to ensure patients “have skin in the game,” many insurance plans began disallowing copay coupons to count toward their deductibles this year. Under these plans, insurance companies now expect patients who use copay coupons to also personally pay their deductibles, dramatically increasing their out of pocket costs. Known as “copay accumulator” programs, these plans have been branded by insurers with Orwellian names such as Coupon Adjustment: Benefit Plan Protection program and Out of Pocket Protection program. In reality, they offer patients the opposite of protection by exposing them to significant deductible costs.
Under such accumulator programs, patients will face significant costs in the middle of the year when they pick up their prescriptions thinking that their deductibles have already been reached. This lack of transparency hides patients’ true out of pocket costs, which they need to understand clearly to budget. Such marketing is deceptive.
Proponents’ argue that by requiring users to pay the full cost of their deductibles they will become more cautious about their health-care spending and choose cheaper alternatives. This is a slap in the face to those living with chronic illnesses. More importantly, it overlooks the fact that for many conditions, cheaper alternatives do not exist.
According to a recent USC study, 90 of the top 200 drugs use coupons. Of those 90 medicines, 71 have no generic equivalent. The “cheaper alternative” for many patients on fixed incomes is not taking their needed medications at all. In other words, it’s true that copay accumulator programs will decrease patient use of their medicines. But at what cost? For the other medications, patients deserve choice because those that work for one patient may not work for another.
Copay coupons allow patients to meet their copays and deductibles, while providing insurance companies their full compensation. They improve access to vital medications at a time when millions of Americans are struggling to pay for them. They must be protected.
Terry Wilcox is the co-founder and executive director of Patients Rising, a patient advocacy organization. This OpEd was first published in Real Clear Health on April 19, 2018.
