October 10, 2016
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Copay assistance programs not solution to high drug prices

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Copay assistance, a seeming resolution to the drug pricing dilemma, is actually the problem, according to a commentary published in Annals of Internal Medicine.

The 600% price hike of Mylan’s EpiPen over a period of 8 years is the most recent outcry regarding expensive drug prices, Peter A. Ubel, MD, of Duke University and Peter B. Bach, MD, of Memorial Sloan Kettering Cancer Center, wrote in their commentary.

Instead of lowering prices to directly ease the financial burden for consumers, Mylan and many other drug companies offer coupons to cover part of patients’ out-of-pocket expenses. Although it may seem like a benefit for public health, “such copay assistance ... is actually a recipe for higher health care costs in the future,” Ubel and Bach wrote.

They argue that insurance companies reduce coverage when pharmaceutical companies increase drug prices which forces patients to pay higher out-of-pocket costs. In addition, they assert that copay assistance programs diminish the public uproar over substantial price increases, allow insurance companies to raise premiums, offer limited support, reduce insurers’ ability to negotiate out-of-pocket costs and act as an impediment for the inclusion of cost in consumers’ decision-making process. These features “weaken the pressure on pharmaceutical companies to lower the price of their products,” they wrote.

“Some near-term policy approaches could mitigate [their inflationary effect on drug prices], but in the long-term, we need to address the underlying problem — the disassociation of drug prices from the benefits those drugs deliver,” Ubel and Bach concluded.

In an additional commentary on drug pricing, Rachel E. Sachs, JD, MPH, of Washington University School of Law and Austin B. Frakt, PhD, of the Veterans Affairs Boston Healthcare System, suggest that public health implications are not being recognized by current pricing policy guidelines.

“If the government limits manufacturers' ability to recoup the costs of risky research and development, including investments that fail to lead to marketable drugs, manufacturers will simply reduce their investment in developing new drugs,” they wrote. “The drugs we may need in the future may not be available.”

Instead of the current innovation-access model, Sachs and Frakt state that policymakers should implement more innovation-innovation tradeoffs to encourage the development of drugs that will hold more benefits for patients while producing superior social value. They note that the medications patients take every day are more profitable for drug companies than cures or preventive interventions. Sachs and Frakt argue that drug prices for cures and prevention products would be higher if drug prices correlated with cost-effectiveness which would prompt pharmaceutical companies to invest more in developing these types of products.

Virginia A. Moyer, MD, MPH, of the American Board of Pediatrics, and colleagues discuss the consequences of linking insurance coverage to US Preventative Services Task Force (USPSTF) guidelines in a third commentary on high drug prices.

Moyer and colleagues emphasize that “financial access comes at the cost of increased deductibles or copays for equally important services that are not preventive.” This may unintentionally deter patients from other important care, they said.

They noted that the USPSTF's A and B recommendations are covered by the Affordable Care Act and deal with preventive services and asymptomatic individuals. While these criteria "are only distantly related to Mylan's product," the company attempted to lobby the USPSTF.

“The American public is best served by an independent scientific process free from advocacy and political pressure. If the only way to assure such independence is to sever the direct linkage to coverage, then ... perhaps it is time for the USPSTF to inform, but not determine, coverage,” Moyer and colleagues concluded. – by Alaina Tedesco

Resources:
Moyer VA, et al. Ann Intern Med. 2016; doi: 10.7326/M16-2304.
Sachs RE, et al. Ann Intern Med. 2016; doi: 10.7326/M16-2167.
Ubel PA, et al. Ann Intern Med. 2016; doi: 10.7326/M16-1334.

Disclosure: Please see the full commentaries for complete list of relevant financial disclosures.