Déjà vu? PhRMA rolls drug cost ads, insurers push back—this time on costly coupon rules

Woman paying for a prescription at a pharmacy
Copay accumulator programs are in the spotlight—as a rising trend and as the subject of new ads from PhRMA. (Getty/Tom Merton)

PhRMA’s latest round of drug cost advertising defends a favorite marketing technique—the copay coupon—against new payer programs that aim to thwart it. Caught in the middle, the ads point out? Patients and their out-of-pocket costs.

Copay coupons make drugs less expensive for patients because drugmakers pitch in on their out-of-pocket costs. But payers hate them, because they're one way pharma persuades patients to use more expensive brands.

Enter the villain in PhRMA's ads: the copay accumulator program, which doesn't allow drugmakers'  supplemental spending to count toward patient deductibles and out-of-pocket maximums.

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Both UnitedHealthcare and Express Scripts have adopted accumulator programs, and some industry watchers predict the idea will gain steam—and debate. Amgen and Pfizer both recently said they're watching copay accumulator programs as a potential threat. And ZS consultants urged pharma companies to take action to address the “pain points” of those programs earlier this year.

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In PhRMA’s new ad message—part of its “Let’s Talk About Cost” series—it says copay accumulator programs “could result in patients facing thousands of dollars in unexpected medical costs.” The ads will run in print, radio, digital and social channels in Washington, D.C., and select states.

But at least one insurance association is firing back, calling pharma’s use of copay coupons “distraction tactics” and “kickbacks.” America’s Health Insurance Plans (AHIP) said pharma coupons are the problem, not accumulator programs.

“When you look at these federal anti-kickback rules around healthcare, it’s been interpreted by the federal government that it would include coupons. And the reason why is that at the end of the day coupons essentially are used to drive up utilization of brand name medication,” said Daniel Nam, executive director of federal programs for AHIP. Federal health programs such as Medicare don't allow patients to use copay coupons.

Part of the reason insurers are introducing copay accumulator programs is to get a clearer picture of the drug cost landscape that pharma has muddied with coupons, Nam said in an interview. It can be tough to track how much patients are spending in coupons and how much they’re spending of their own money toward deductibles.

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“Pharma companies are really trying to push people into a space where plans and insurers and payers are going to be on the hook for more money for their products," he said. "When you look at (coupons) from a plan-benefit structure point of view, it’s overturning the deductible phase, it’s overturning the copay structure and a lot of the decisions and mechanisms put into place by the plan to ensure cost efficient care."

PhRMA’s counter? “Copay coupon programs offered by biopharmaceutical companies provide a valuable source of assistance for many commercially insured patients who are facing rising out-of-pocket costs because of deteriorating insurance coverage for medicines,” said Stephen Ubl, CEO and president of PhRMA, in a statement.

The upshot, Ubl said? Patients aren't filling prescriptions if they have to shell out up front under high-deductible plans. He pointed to research that showed “brand prescriptions subject to a deductible are more than twice as likely to be abandoned at the pharmacy than those not subject to a deductible.”

In a February article, Axios said copay accumulator programs are "the drug pricing issue that could erupt this year." They predict drug companies and insurers will blame each other, while patients may get caught in the middle. It quotes Harvard health economist Leemore Dafny as saying, "In the short term, consumers are going to be potentially devastated by the sudden change in out-of-pocket spending. In the long term, it's a cost-control measure that is long overdue."

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