![]() ![]() Some health plans restrict the use of copay coupons toward deductibles by implementing copay adjustment programs. Pharmacy benefit managers (PBMs) and insurance companies offer various tools to encourage patients to choose lower cost drug options. Moreover, they say, copay coupons do not reduce the overall price of a drug but simply shift the cost to health plans, which increases premiums. Opponents argue copay coupons incentivize the use of brand-name drugs over generics or lower cost brand-name drugs, contributing to higher health insurance premiums. Second, the value of the coupon may also be applied to a patient’s annual cost-sharing requirement, like deductibles. First, they reduce the amount a patient pays at the pharmacy counter when they fill their prescription. These assistance programs are intended to help limit patients’ out-of-pocket costs in two ways. Manufacturers may offer copay assistance coupons to patients to help offset the cost of their prescriptions. ![]() Additional research shows specialty drugs make up 37.7% of retail prescription drug spending, even though they account for a small portion of prescriptions filled. In one analysis, researchers evaluated the prices of six specialty drugs between 20 and found prices rose on average 57%, while prices for generics decreased 35%. Many chronic conditions are treated with biologics (drugs made from living cells), brand-name or “specialty” drugs, which can be particularly costly. In fact, data from a Kaiser Family Foundation poll shows 1 in 4 Americans reporting difficulty affording their medicine. Prescription drugs are often a vital part of a person’s daily health regimen, but the cost of treatment can be a barrier for some. ![]()
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