Copay Accumulator Update: Widespread Adoption As Manufacturers and Maximizers Limit Patient Impact

In January, I alerted you to an important new benefit design trend in Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit. It is by far the most widely read article ever published on Drug Channels. New data from Zitter Health insights (ZHI) suggest that these programs are widely used. Nearly one-third of commercially-insured lives are enrolled in plans that have implemented copay accumulator adjustment or closely-related copay maximizers. (We explain the benefit design math behind maximizers below.) ZHI also found that a surprising number of plans are already set up to use these programs, but have not done so … Continue reading Copay Accumulator Update: Widespread Adoption As Manufacturers and Maximizers Limit Patient Impact

Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2018. Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs—a benefit design option that I expect to become highly controversial this year. Accumulator programs target specialty drugs for which a manufacturer provides copayment assistance. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum. As you will see below, plan sponsors—employers and health plans—will save big money because accumulators shift a majority of … Continue reading Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit (rerun)

Drug Channels News Roundup, March 2018: Copay Accumulators, Cancer Drug Costs, Physician Employment, and Insurer Profits

It’s technically spring here at Drug Channels’ worldwide headquarters in lovely downtown Philadelphia. While the last snowdrifts melt into memory, please enjoy this month’s selection of noteworthy news stories. You’ll learn: Why copay accumulators are making national news How hospitals are doubling cancer drug costs Fun facts about the massive shift to hospital-employed physicians Plus, a joke (I think) about how a major health insurer makes money. P.S. Join the nearly 5,400 people who follow me at @DrugChannels on Twitter. I share links to crucial news and reports that you should know about. Read more » Copyright © 2006-2018 Pembroke … Continue reading Drug Channels News Roundup, March 2018: Copay Accumulators, Cancer Drug Costs, Physician Employment, and Insurer Profits

Drug Channels News Roundup, February 2018: Walgreens Boots Alliance + AmerisourceBergen, Copay Coupons, and Amazon

Winter—or at least February—is almost over! Bid farewell to the shortest month of the year with this curated selection of noteworthy news. In this issue: A few thoughts on a Walgreens Boots Alliance-AmerisourceBergen deal Watch a fun panel discussion on copay coupons The latest on Amazon’s ambitions for medical products Plus, The Onion provides an additional update on Amazon’s healthcare plans. P.S. For my daily updates on news and neat reports, follow @DrugChannels on Twitter. My recent tweets have covered copay accumulators, Medicare Part D, the 340B program, M&A rumors, healthcare economics, and more. Read more » Copyright © 2006-2018 … Continue reading Drug Channels News Roundup, February 2018: Walgreens Boots Alliance + AmerisourceBergen, Copay Coupons, and Amazon

Exclusive Express Scripts Data: Most People Have Very Low Out-Of-Pocket Prescription Costs

In New Express Scripts Data: The Drug Spending Slowdown Is Real, I analyzed the latest drug trend report from pharmacy benefit manager (PBM) Express Scripts. To complement our earlier analysis, Express Scripts was kind enough to provide Drug Channels with an exclusive analysis showing the distribution of out-of-pocket costs for nearly 26 million people. Despite consumer surveys complaining about “high drug prices,” the reality is that most people don’t pay much for their prescriptions. In 2017, about 95% of people with commercial insurance had less than $40 per month in out-of-pocket prescription costs. About half of them paid nothing, because … Continue reading Exclusive Express Scripts Data: Most People Have Very Low Out-Of-Pocket Prescription Costs

Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit

Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs—a benefit design option that I expect to become highly controversial this year. Accumulator programs target specialty drugs for which a manufacturer provides copayment assistance. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum. As you will see below, plan sponsors—employers and health plans—will save big money because accumulators shift a majority of drug costs to patients and manufacturers. Accumulator programs will further lower a plan’s drug spending by discouraging the appropriate utilization of specialty therapies and reducing adherence. What’s … Continue reading Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit

Five Fun Facts About the New Express Scripts-GoodRx Drug Discount Partnership (rerun)

This week, I’m rerunning some popular posts while I’m on vacation. Click here to see the original post and comments from May 2017. Last week, the pharmacy benefit manager (PBM) Express Scripts and the online discount card company GoodRx partnered on a new program called Inside Rx. The program provides point-of-sales discounts to uninsured patients on at least 40 brand-name drugs from eight manufacturers. Click here to read the press release. This innovative partnership is the latest attempt to offer direct-to-consumer discounts that pop the gross-to-net bubble—at least for uninsured patients. Below, I delve deep inside Inside Rx. I explain: … Continue reading Five Fun Facts About the New Express Scripts-GoodRx Drug Discount Partnership (rerun)