A new trend has more health insurers implementing what are known as co-pay accumulator programs, which change how patients meet their annual deductible. Insurers embrace the programs to increase their revenues and discourage the use of high-cost drugs. But, in so doing, they leave patients with a difficult choice.
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.
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.
Skin is an organ like no other. It can be seen and touched; it is instantly visible on ourselves and others. And in addition to dictating much of our outward appearance—which has vast social significance—our skin allows us our sense of touch and serves as armor protecting us from hostile environments and microbes.
Just as skin serves multiple functions, conditions impacting our skin can have a multifaceted impact. People who have skin conditions may experience feelings of isolation due to how the appearance of their skin is perceived. For patients with conditions like psoriasis or eczema that are connected to stress, these feelings can be doubly painful—isolation breeds stress, which in turn exacerbates the condition. Skin conditions can undermine a patient’s ability to function at work, school, home, or other social situations, meaning they can have a serious impact on a patient’s financial security and emotional stability.
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.