What happens when a health plan drives diabetes patients to switch their medication, insulin, or medical device?
For some patients, nothing. But for others, being forced to switch can cause real problems.
For many patients with complex, chronic conditions, the process of identifying the right combination of medications takes considerable effort. Imagine then how patients feel when their insurance company forces them to change their medication on the basis of cost.
Co-pay coupons are a common tool to help patients with chronic conditions cover the cost of expensive medications. Historically, co-pay coupons’ value has counted toward a patient’s annual deductible. Once the deductible is met, the patients pays a modest co-pay – a fixed amount – per prescription.
The story has become a familiar one. A patient with a chronic condition works with his or her doctor to find the right treatment. The condition is stabilized, manageable.
But then that stable patient is driven by the insurance company to a drug that’s less expensive. The switch prioritizes insurers’ profit over patients’ health. And it often comes with consequences: new side effects, re-emerging symptoms that had been under control, or interactions with medication the patient takes for other conditions.
Now, for the first time, a national study puts data points behind the story – providing a clear, measurable look at the qualitative impact of non-medical switching. This report details the findings of two in-person focus groups as well as a national poll of 800 patients who experienced non-medical switching firsthand.
Not everyone can afford the medication they need. To make drugs more accessible, manufacturers sometimes provide co-pay coupons to help patients cover their out-ofpocket pharmacy expenses.
Manufacturers have issued co-pay coupons since the mid-2000s, but they have become more common in recent years. The amount of prescriptions paid for using coupons reached 19 percent in 2016.
Most drugs that have co-pay coupons don’t have lower-cost generic alternatives. For the few that do, these alternatives may not suit the unique characteristics of a patient’s medical history or disease state. Or, a patient has already tried the less expensive option and found it ineffective.
Regardless of what may be available, doctors should be trusted to prescribe the most appropriate medication for their individual patients. And when a doctor prescribes a costly regimen, until recently, patients could depend upon co-pay coupons to count toward their yearly out-of-pocket deductible. Many patients relied on this arrangement to access their medications.
Yet for patients across the country, that reality is changing.
Almost 1 in 10 Americans – men, women, and children of all ethnicities and income levels – has diabetes. One of the most common medical conditions in America, diabetes has become more widespread in recent years, increasing by more 1 million people between 2012 and 2015 alone.
Not surprisingly, diabetes is an expensive disease. In 2017 diabetes cost the United States $237 billion in direct medical costs and $90 billion in reduced productivity, accounting for about one in every four health care dollars spent. People with diabetes incurred an average per-patient cost of $16,750 a year.
Diabetes’ impact and prevalence demand policies that allow people to access appropriate medications and effective health care.