Patient Drug Payment Assistance Programs

By August 13, 2019 Commentary

Brand name prescription drugs, especially specialty ones, are expensive and patients often face an increased cost-share for these drugs.  Manufacturers sometimes offer direct help through “copay assistance” programs, which have been controversial because of their tendency to increase the use, sometimes inappropriately, of expensive drugs, even when generics may be available.  Payers have found various methods to fight back against these programs, and in Medicare and Medicaid such programs likely violate the anti-kickback laws.  Another approach is for “charities” to provide assistance in paying for medications.  A study in the Journal of the American Medical Association takes a closer look at these charities, and the results have to make you more than a little suspicious that these organizations are thickly-veiled efforts by drug companies to promote use of their high-cost products.   (JAMA Article)   Between 2007 and 2016 the total amount of aid dispensed by these charities expanded by almost 600%.  The authors examined the 6 largest independent charities.  The revenue of these organizations ranged from $24 million to $532 million.  They had a total of 274 disease specific medication assistance programs, with the most common area being for cancer.  Eligibility limits were generally income of around five times the federal poverty line, so these aren’t often destitute patients.

The median annual cost for the drugs covered by the programs was $1157, compared to $367 for non-covered medications.  Now this could just be an attempt to direct help where it is needed most, at the most expensive compounds.  But the programs were much more like to cover off-patent brand-name drugs than generic equivalents.  The most telling thing is that these charities don’t reveal their donors, with one exception, and the drug companies are permitted to make donations.  For the one exception, 6 of the 7 largest donors were pharmaceutical manufacturers.  In addition, the charities don’t typically disclose the patient eligibility criteria.  It appears however, that the real criteria may be that a person receiving assistance will be prescribed a donor medication maker’s product.  The Department of Justice in the last two years has nailed 7 drug companies for misbehavior related to these charities, including basically using them as fronts to promote more use of their products.  I am deeply concerned about the high cost of drugs for patients; but these organizations are the wrong way to address the problem.  They encourage overuse and they allow manufacturers to perpetuate high-prices for everyone else.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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