A group representing people with HIV and diabetes argues that sick patients have higher drug costs by preventing them from applying billions of dollars in aid to insurance deductibles Medicare I am trying to abolish the rule.
Big picture: A federal lawsuit filed by the group on Tuesday addresses the larger question of whether pharmaceutical companies can cover Medicare copays for expensive drugs or whether covering patient costs amounts to bribery. I’m here.
Zoom in: A lawsuit in the U.S. District Court for the District of Columbia focuses on “self-pay coupons,” which drug companies offer to give patients a better deal and ultimately to boost drug sales.
- insurance companies began to use–To prevent patients from applying these discounts to their out-of-pocket amounts, I called on the co-pay accumulator.
- However, patient groups including the HIV+Hepatitis Policy Institute, the Diabetes Leaders Conference (DLC), and the Diabetes Advocacy Coalition (DPAC) argue that federal regulations define cost sharing as follows: Respect for intrinsic health benefits. ”
- “It doesn’t matter if the support comes from a friend, a charity, or a pharmaceutical company,” they wrote.
A CMS spokesperson said: The agency has not commented on the pending lawsuit.
What they say: Due to increasing deductible and cost-sharing requirements, patients often rely on co-pay assistance to purchase prescriptions, said Karl Schmidt, executive director of the HIV+ Hepatitis Policy Institute. I’m here.
- “They receive copays provided by pharmaceutical companies, which totaled $12 billion last year…which is for patients, but the deductible or out-of-pocket amounts for patients are Not included,” Schmidt said in a call with reporters. .
Opposite side: Research shows that drug coupons drive up costs overall by encouraging patients to seek out drugs from specific companies. Doctors are happy to prescribe it because they know it will not cost their patients. But taxpayers are likely to take up most of the tab.
this is part Ge Bai, a professor of accounting and health policy at Johns Hopkins University, told Axios that the elaborate dance between pharmaceutical companies and insurance companies extends beyond Medicare to private insurance.
- Insurance companies use copays and co-insurance to keep patients away from more expensive drugs. That’s why manufacturers are offering out-of-pocket assistance schemes, Bai said.
- She said insurance companies are turning to out-of-pocket accumulators because it is no longer easy to steer patients to cheaper alternatives.
- Leemore Dafny, a health economist at Harvard University, told Axios:
- “That’s not to say cost sharing isn’t without big downsides,” she said. “What that means is that it shouldn’t be the pharmaceutical companies that are setting it up.”
This will eventually “Pharmaceutical manufacturers inflate list prices and PBMs distort prescription books to encourage them to favor higher-priced, higher-rebate treatments,” the authors write.
- Another battle rages in Medicare over eliminating kickbacks that drug companies pay pharmacy benefit managers in exchange for preferential formulary placement. These rebates are passed on to the insurer, resulting in lower premiums for members.
- The Inflation Reduction Act delayed implementation of a Trump-era that would void certain manufacturer rebates paid to Medicare’s drug coverage plans until 2032.
To the point: “This war will continue. Both parties will continue to make new plans,” Bai said.
