As reported by Kaiser Health News:
The value of drug manufacturers’ copay cards has become more unpredictable as insurers are attempting to restrict their use. For example, many insurance plans do not count copay program money toward a patient’s deductible amount.
And patients who use copay cards may pay full or nearly full price instead of a discounted rate negotiated by their insurer’s pharmacy benefits manager.
“A manufacturer coupon was used when you purchased your medication,” Mishra’s explanation of the benefit details read, in small print. The amount covered by the copay card “was not applied toward your deductible and out-of-pocket maximums.”
Caroline Landry, a spokeswoman for UnitedHealthcare, said that “the copay card is an arrangement between the patient and the pharmacy. It is used outside of insurance.”
In an email statement, Amgen spokeswoman Elissa Snook expressed a different perspective on who was responsible for Mishra’s dilemma: “Copay assistance programs are designed to help patients initiate and stay on prescribed therapy, but the value of that assistance can be eroded more quickly when a health plan requires patients to pay the full list price of a drug.”
What do patients do when insurers don’t honor copay cards? Medication adherence decreases dramatically.
…Aware of how much the drug would cost in November and December, Mishra said, he tried to spread the remaining pills from the starter pack and the first two months’ supply. She skipped a few days and took only half the prescribed dose to stretch the supply to two months, knowing she would get a new copay card with the new year. Many of his symptoms returned, he said.
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