Copayment assistance from manufacturers, and how it might change.
Major pharmaceutical manufacturers have historically helped patients in the bleeding disorder community by assisting them with their copayment, which is usually reached within the first month of treatment, or shortly thereafter. That practice might be changing, because the manufacturer’s payment assistance is no longer being applied to the patient’s deductable by insurance companies. Instead, co-payment assistance is being used to pay just for the prescription. Have I lost you? I’ll explain further…
Historically, a manufacturer’s assistance toward the co-payment would save the patient from being hit with a $5,000.00 bill on day one, however, some insurance companies are changing the way co-payment assistance works. Instead, the manufacturer payment assistance is used to just pay prescriptions until the maximum value of the manufacturer’s co-payment program is reached. After that point, the patient’s out-of-pocket payments begin counting toward their annual deductible and out-of-pocket maximum. It’s like starting from zero midway into your insurance year.
An example would be that an insurance plan has a co-payment of $5,000.00, which means, for a patient with a bleeding disorder, the insurance company expects the patient to pay $5,000.00 first, before the rest of the costs are covered by the insurance plan. As we know, in the bleeding disorder community, this means patients are probably hit with a $5000.00 bill on day one because treatment will be more than the co-payment within the first month. The manufacturer would pay the $5,000.00, saving the patient from this hit. However, insurers are no longer considering the $5,000.00 to be a payment towards the deductible. Instead, they accept the manufacturers payment, and consider it a direct payment for prescription. In a nutshell, once these manufacturers assistance limit is reached, the patient starts from scratch owing their deductible.
Of course, this is an oversimplification, but a real issue affecting the bleeding disorder community.
NEBDAC will be following this issue in 2018.
What is a deductable? Read here for a good, description.
What is a co-payment? Read here for a good, description.