Copay Assistance Programs. Jennifer C. Chen, MPH Center for Health Policy & Outcomes Memorial Sloan Kettering Cancer Center

Transcription

1 Cpay Assistance Prgrams Jennifer C. Chen, MPH Center fr Health Plicy & Outcmes Memrial Slan Kettering Cancer Center 1

2 Overview I. Why des cpay assistance exist? II. Hw d they wrk? III. What effect d they have n the healthcare system? IV. Plicy recmmendatins 2

3 Why des cpay assistance exist? Relatinship between health plans/pbms and manufacturers Health plans/pbms create frmularies with multiple tiers as a way t steer vlume t and away frm particular drugs Lw tier = lw cpay / c-insurance = higher patient utilizatin Manufacturers ffer rebates in exchange fr frmulary placement But what if the manufacturer gets shut ut, r the rebate vs placement tradeff isn t favrable?. Enter the cpay supprt. Side-step negtiatin prcess by access cnsumers directly Cupns alleviate the patient OOP burden and helps vercme the access barrier s can keep drug cst high, stay n a high tier, get patient access Example: Mylan ffers 50% ff yur cpay fr the Epipen! Takeaway: OOP cst limits access, s want access 3

4 Types f cpay assistance prgrams Insurance types Descriptin Cmmercial Gv t Uninsured Level f Supprt Manufacturer-spnsred cpay supprt Prgrams that ffset patients cst-share Charitable fundatin Indicatin-specific charities t help patients with financial need x Drugspecific Diseasespecific Details Cntrlled by CF Funding surce Dnatins, incl. frm PBM-spnsred cpay supprt Prgrams that prvide high-deductible plans and uninsured patients with discunted drug prices Drugspecific PBM PBM Patient Assistance Prgrams Free prduct fr uninsured patients and thse n high-deductible health plans Drugspecific CF / HCP samples, quick start & bridge prduct Free prducts prvided by s t HCPs r directly t patients t nbard and maintain them n paid therapy Drugspecific Gv t = gvernment; = manufacturer; PBM = pharmacy benefit manager; CF = charitable fundatin; HCP = health care prvider 4

5 Manufacturer-spnsred cpay cupns Manufacturers ften use cpay cupns fr 1. Branded drugs that are facing generic cmpetitin Of drugs facing generic cmpetitin, spending n 23 drugs with cupns was $700 M t $2.7 Bn higher than it wuld have been if cupns had nt been issued Dafny et al. 2. In therapeutic areas withut generics but with intense brand-against-brand cmpetitin 3. Others Rare diseases? Specialty drugs? Dafny LS, et al. (2016) Undermining Value-Based Purchasing Lessns frm the Pharmaceutical Industry. NEJM.rg 5

6 Hw d cupns wrk? 6

7 What effect d cpays have n the healthcare system? Diminishes price pressure, reduces public utcry Keeps patients frm acting as cnsumers, reduces level f scrutiny fr measuring cst and quality Undermines high-deductible / lw-premium benefit designs and shifts financial burden t the insurer Undermines high-deductible / lw-premium plans that shift cst t patient Meant t inhibit unnecessary health care utilizatin and spending, theretically lwers ttal health care expenses Pressures insurers t increase premiums, especially if cupn is undetected Reduces negtiating leverage fr insurers Circumvents frmulary tiering, allws drug t be high cst with cntinued usage 7

8 Market sizing exercise fr specialty cpay supprt (a grss underestimate) Understand the financial value and general scpe f cmmercial cpay supprt. Used existing literature and IQVIA 2018 data fr back-f-the-envelpe estimates that shwed patients received $5.2 billin in cpay supprt fr specialty pharmaceuticals dispensed thrugh retail pharmacies in Lack f rbust data fr ther distributin channels (mail service, nn-retail). Cpay cupn inputs nt currently available at brand level. Retail (chain stres, fd stres, independent) Ttal prescriptins 4,990,000,000 Ttal specialty Rx 94,810,000 (1.9%) Ttal specialty Rx, cmmercial 47,594,620 (50.2%) Utilizing cpay 19,989,740 (42%) Specialty avg. buydwn $261 Ttal manufacturer buydwn, specialty $5,217,322,244 Estimate des nt include: Any gvernment prgram Mail rder and institutinal channels Cpay assistance prgrams 8

9 Enter the cpay accumulatr Plan recrds $300 cpay supprt and $ OOP spend 9

10 Plicy recmmendatins fr cpay assistance equity and limits n drug price inflatin Actr Pharmaceutical cmpanies Actin Offer similar cpay assistance fr all cmmercial patients n all their prducts fr duratin patient needs medicatin. Pharmacies Medicaid Plicymakers Publicly register all prgrams fr easier identificatin by patients and prviders. Mandatry reprting f cpay assistance, aide cpay accumulatrs. Include cpay assistance in determinatin f best price flrs. Implement value-based pricing, with larger prfits assciated with mre clinically beneficial drugs. Ubel PA, Bach PB. Cpay Assistance fr Expensive Drugs: A Helping Hand That Raises Csts. Ann Intern Med. ;165: di: /M

11 Thank yu 11