The Prescription Drug Copayment Coupon Landscape · The Prescription Drug Copayment Coupon...
Transcript of The Prescription Drug Copayment Coupon Landscape · The Prescription Drug Copayment Coupon...
The Prescription Drug Copayment Coupon Landscape
Geoffrey Joyce, PhD, Karen Van Nuys, PhD, Rocio Ribero, PhD and Dana P. Goldman, PhD
Leonard D. Schaeffer Center for Health Policy & Economics, USC
DISCLOSURES
This work was supported by the Leonard D. Schaeffer Center for Health Policy
& Economics and by the National Institute on Aging of the National Institutes
of Health under Award Number P01AG033559. The content is solely the
responsibility of the authors and does not necessarily represent the official
views of the National Institutes of Health or the Schaeffer Center.
3
Source: International Federation of Health Plans 2015
Comparative Price Report
$822
$1,362
$2,669
Switzerland United Kingdom United States
Average Price of Humira (2 Syringes, 2015)
4Source: KFF Tracking Poll, Sept 2016
Most Americans favor action to keep drug prices
down
71%
78%
82%
86%
Requiring drug companies to release information to the public on how they set their drug prices
Allowing Medicare to negotiate with drug companies for lower drug prices
Limiting the amount drug companies can charge for high-cost drugs for illnesses like hepatitis or cancer
Allowing Americans to buy prescription drugs imported from Canada
5
Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScan
Commercial Claims and Encounters Database, 2004-2014
Distribution of Cost-sharing Payments for Rx
Drugs in Large Employer Plans
24%
19%
16%
17%
14%
11%
11%
10%
8%
4%
4%
20%
17%
15%
11%
7%
8%
8%
9%
6%
4%
3%
56%
64%
69%
72%
78%
82%
82%
81%
85%
92%
93%
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
Rx deductible spending Rx coinsurance spending Rx copay spending
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Should Copay Coupons Be Banned?
• Offered by pharmaceutical manufacturers
• Increasingly common, but controversial tool to address
high out-of-pocket costs
• Currently banned from federal programs
• Banned in MA, but repealed in 2012
• Several states (CA AB-265) prohibit coupons for
drugs with a generic equivalent
• Response of commercial plans
• No credit towards deductible
7
Policy QuestionShould government enact legislation banning
copay coupons?
• Copay coupons reduce or eliminate copayment
required by the health plan
o Glass half-full: Improves access by reducing
patient out-of-pocket costs
o Glass half-empty: Circumvents plan benefit
design
Patients fill more expensive therapies, raising
total drug expenditures
8
200 Highest
Expenditure Drugs in
2014
132 Brand Name
90 With
Coupons71
No Generic Equivalent
11 No CTS
68 Generics
42 No
Coupon
12 Competing
with Generic Equivalent
7 Facing Generic Entrant
25 Generic
CTS35
Only Single-Source
CTS
Coupon and Generic Status of 200 Highest-Expenditure
Drugs in 2014
Brand Name Drugs
Couponed Drugs
9
12%
28%
45%
15%
<$5 $5-$10 $10.01-$25 >$25
Distribution of Monthly Copay Goal
14%
32%
48%
6%
<$500 $500-$1000 $1000.01-$10000 >$10000
Distribution of Annual Aid Cap
52%
47%
Mention No Mention
Distribution of Duration
33
19
15
Set # Uses Set Date Set Duration
Distribution of Duration Types
10
200 Highest
Expenditure Drugs in
2014
132 Brand Name
90 With
Coupons71
No Generic Equivalent
11 No CTS
68 Generics
42 No
Coupon
12 Competing
with Generic Equivalent
7 Facing Generic Entrant
25 Generic
CTS35
Only Single-Source
CTS
Coupon and Generic Status of 200 Highest-Expenditure
Drugs in 2014
Brand Name Drugs
Couponed Drugs
11
200 Highest
Expenditure Drugs in
2014
132 Brand Name
90 With
Coupons71
No Generic Equivalent
11 No CTS
68 Generics
42 No
Coupon
12 Competing
with Generic Equivalent
7 Facing Generic Entrant
25 Generic
CTS35
Only Single-Source
CTS
Coupon and Generic Status of 200 Highest-Expenditure
Drugs in 2014
Brand Name Drugs
Couponed Drugs
12
11
25
35
No CTS Generic CTS Only SS CTS
Close Therapeutic Substitutes of 71 Single-Source Couponed Drugs
Distribution
by Type of CTS
21
9
5 No Couponed Drugs AmongLPCTS
CTS has Couponed Drugs,LPCTS not Couponed
LPCTS is Couponed
13
19
11
25
35
Drugs
with
no
CTSDrugs with
generic
equivalentDrugs with
generic CTS
Drugs with only
branded CTS
Impact on Therapeutic Options
Likely Impact of Coupons on Differing Competitive Landscapes
Impact on Expenditures
Raises
Lowers
ExpandsNeutral
WORSE
BETTER
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Summary of Findings (2014)
• Coupons are a strategic response to
o Higher patient cost-sharing
o PBM control and consolidation (pick winners & losers)
• Can weaken formulary compliance
o 1 in 5 coupons steer patients away from generic
equivalent
o 1 in 8 coupons are for single-source drugs with no close
therapeutic substitute
o Remaining coupons (2/3rd) are for drugs with imperfect
therapeutic substitutes
40% have a CTS that is generic
60% have only branded CTS (often similar in price;
most also couponed)
15
Total Ban is Unwarranted
• Coupons are a symptom, not the disease
o Ban would reduce access for some patients
o At least coupons direct savings to the user
• Total ban favors one part of the supply chain
(PBMs and payers) over another
(manufacturers)
• While many are complicit in rising drug costs
o Economic rents (profit) should be proportional to the
value added
o Manufacturers take biggest risk and are the primary
innovators in the industry
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