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.
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.