![]() “It is important to remember that while manufacturer-sponsored programs, such as copay cards, can help reduce out-of-pocket costs for patients in the short-term, they can also lead to increased health care costs in the system by encouraging the use of higher cost, often branded drugs,” Christine Cramer, senior director of CVS Health’s corporate communications, emailed this month.Ī copay accumulator likely triggered Burgess’ panicked call in 2017. That often means that when the assistance from the drugmaker - which is generally limited to a fixed dollar amount - runs out, the patient is on the hook for a much larger share of the cost of the drug. Patients can use a copay card or coupon to help cover the cost of the drug, but the payment does not count toward their insurance plan’s deductible or out-of-pocket maximum. Insurers and pharmacy benefit managers like CVS Caremark and ExpressScripts have begun refusing to use copay cards as the drugmakers intended.ĬVS Caremark introduced “copay accumulator” programs two years ago. California passed a law last year limiting their use and federal litigators have increased scrutiny. Insurers and lawmakers have begun to push back against the popular copay programs, saying they raise the cost of medications in the long run. ![]() ![]() This approach will “create a new black hole of patient-directed payments and avoid any scrutiny,” he said. “All of these programs try to help patients afford the medications,” said Totonis, whose company bought PSKW, which issued the check Burgess received from Amgen in 2017.ĭaniel Nam, executive director of federal programs for AHIP, the America’s Health Insurance Plans, said direct reimbursement using checks is just another way for manufacturers to make insurance companies pay for expensive drugs, which helps jack up monthly premiums. He declined to confirm the average value of the checks or name the drugmakers that issue checks via ConnectiveRx. Harry Totonis, chief executive of ConnectiveRx, a pharmaceutical services company, said sending checks to patients is “not a commonly used practice” and happens “a fraction of 1 percent” of the time. While Amgen’s primary assistance is through copay cards, “in some instances, based on patient preference, Amgen will provide direct reimbursement” after a patient has already paid for the medicine, Amgen’s Kristen Neese, director of corporate affairs, said in an emailed statement. ![]() When the cards fail to work, for whatever reason, Amgen can send direct reimbursement. The federal anti-kickback and Stark laws were meant to prevent bribery of patients and doctors and do not apply to private commercial insurance plans.ĪbbVie, which makes the blockbuster arthritis drug Humira, will send a check if patients can prove their copay card doesn’t work for a variety of reasons, said Adelle Infante, director of external communications for the company.Īmgen, the maker of Burgess’ arthritis medicine, provides up to $12,000 of copay assistance each year to commercially insured Enbrel patients who need help meeting out-of-pocket expenses, often regardless of the patient’s financial status. “You can accept cash from anybody as long as it’s not a government program,” Schiffbauer said, noting there may be income tax obligations for the patient. The practice of sending checks is legal as long as the patients are not enrolled in government-funded insurance such as Medicare and Medicaid, said William Schiffbauer, a Washington, D.C.-based health insurance attorney. Please see full Program Terms, Conditions, and Eligibility Criteria at. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Maximum savings limit applies patient out-of-pocket expense may vary. Check with your pharmacist for your copay discounts. When insurance covers VRAYLAR (cariprazine), eligible patients may pay as little as $15 for each of up to four (4) 90-day prescriptions filled. Eligible patients whose insurer does not cover VRAYLAR (cariprazine) or where coverage restrictions have not been satisfied may pay as little as $75 per 30-day supply for each of up to twelve (12) prescription fills. In such instances, eligible patients who have not previously registered for a VRAYLAR (cariprazine) savings card may pay as little as $0 for their first two (2) 30-day fills. †Depending on insurance coverage, eligible patients may pay as little as $5 for each of up to twelve (12) prescription fills. Most new eligible patients may pay $0 for their first two 30-day fills and as little as $5 for 30- or 90-day refills.
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