Position Statements

Telling the Truth About Copay Accumulators

Instead of applying the value of drug manufacturers’ copay cards and coupons to offset patients’ out-of-pocket costs for certain medicines, insurance companies now expect patients who use copay coupons to personally pay their deductibles, which could mean thousands of dollars in unexpected medical expenditures

Rein in the Use of Step Therapy

Decisions about a course of therapy that were once exclusively made by the doctor and patient are now being overturned by a common insurance practice called step therapy,  or what is sometimes called “fail first.” As a result, step therapy costs the nation in lost productivity and higher medical expenditures for increased disease activity, disease progression, more symptom severity, loss of function, and patients’ poorer quality of life.

It’s Time to Reform Prior Authorization Requirements

Although it is now possible to detect diseases earlier and treat them more effectively, the reality is many Americans are not getting timely access to the new technologies and improved therapies responsible for these gains. One reason has to do with prior authorization, a common insurance practice whereby health plans require clinicians to get advance approval before a procedure, service, device, or medication qualifies for payment coverage and can be made available to patients. By imposing non-medically necessary restrictions that block physicians for ordering appropriate care for patients, prior authorization policies postpone needed tests and treatments, potentially worsening health outcomes for patients and leading to higher medical costs when the resulting medical complications require expensive hospitalizations and/or emergency department treatment.

The Need for Patient Assistance and Access Programs 

Many state, non-profit and corporate prescription assistance and access programs (PAPs) help patients obtain free or nearly free medicines if they qualify. Serving as a safety net for the millions of Americans who lack health insurance or whose insurance does not sufficiently cover the cost of the medications they need, PAPs have been in existence for decades and come in different forms – some provide cash subsidies to needy patients, others offer free or discounted products, product coupons, and copayment assistance.

Fighting Nonmedical Switching

Under a practice known as nonmedical switching, pharmacy benefit managers (PBMs) can force patients to change from a medication they rely on to a less costly and possibly less effective drug for financial reasons, not medical ones. PBMs accomplish this by dropping the medication from the formulary or increasing the drug’s cost-sharing requirements – typically after the plan year has begun – and then notifying patients they may need to switch to a less expensive treatment in order to avoid a large increase in out-of-pocket costs.

Safety Concerns with Drug Reimportation

To reduce patients’ spending on prescription drugs, both Congress and a number of states are considering legislation that would allow Americans to purchase supposedly much cheaper medicines from Canada and elsewhere, which could put Americans’ health and safety at increased risk.