Raised eyebrows at patient charity spotlight copay assistance debate

A patient-assistance charity is under scrutiny for potential favoritism toward one of its drugmaker sponsors--and that, in turn, is spawning new criticism of pharma's copay assistance programs.

As The New York Times reports, the Chronic Disease Fund, the largest copay assistance charity, has cleaned house at the top after people started asking questions about its relationship with Questcor Pharmaceuticals ($QCOR). Questcor blames short-sellers for drumming up criticism, but whatever the source, CDF is working to make sure it's "squeaky clean," its attorney, Jeffrey Tenenbaum, told the newspaper.

Questcor makes a pricey drug for immune disorders, H.P. Acthar Gel, that has come under criticism for its $28,000-per-vial price; in fact, some insurers have cracked down heavily on its use. It's the sole treatment for 15 of the 46 diseases CDF focuses on, the Times notes. Like CDF's other sponsors, Questcor donates money for copay help for patients with specific diseases, and as the NYT points out, Acthar is sure to benefit from those donations because of its sole-treatment status. In fact, CDF's list of covered conditions includes a couple that seem tailor-made for Achthar patients. Questcor's CEO has said that its donations to CDF are "the same thing everybody else is doing," the newspaper says.

But the questions raised by Questcor's donations and CDF's operations are only part of the controversy over copay assistance. Drugmakers often fund their own direct assistance programs to help patients cover their share of the cost of expensive brand-name drugs. Biogen Idec ($BIIB), for instance, not only helps with copayments on its new multiple sclerosis drug Tecfidera, but also provides the drug for free for patients who are having trouble winning insurance reimbursement.

That's great for patients, but payers are more skeptical. In the case of genuinely superior treatments--and one can easily argue that Tecfidera qualifies--insurers don't mind copay assistance so much. But for drugs that payers consider merely equal to, or even lesser than alternative treatments, copay assistance rankles.

After all, insurers set high copays and co-insurance to steer patients toward cheaper meds--often generics--before trying more expensive brands. Without the deterrence of paying a higher share of their treatment cost, that steering strategy fails. So, it's not so surprising that, when Express Scripts ($ESRX) set up a new, exclusionary formulary for 2014, drugs supported by copay programs came under additional scrutiny. Some health plans have gone so far as to sue Big Pharma over their copay programs.

Some consumer advocates stand on the payers' side, too: "These subsidies are unfortunately used to promote the overutilization of expensive brand-name drugs," Community Catalyst lawyer Wells Wilkinson told the Times.

And here's where we circle back to the charities. Drugmakers can offer copay assistance to privately insured patients in the U.S. Patients covered by Medicare and Medicaid aren't eligible for pharma's help (although officials recently said Obamacare enrollees will be). But all patients are eligible for charity assistance.

Those charities, including CDF, have seen their donations grow quickly over the past few years, to almost $200 million annually in some cases. And now that CDF is under the microscope, some other patient charities are worried about their own reputations. As Patrick McKercher, president of the Patient Access Network Foundation, told the Times, "We could all get painted with the same brush."

- read the NYT story (sub. req.)

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