For the asking, a check is in the mail to help pay for costly drugs

When financial incentives like copay coupons and debit cards do not provide enough help for consumers, pharmaceutical companies sometimes will write a check—what they call direct reimbursement—to make sure a loyal patient will stay on a high-cost, brand-name drug.

When financial incentives like copay coupons and debit cards do not provide enough help for consumers, pharmaceutical companies sometimes will write a check—what they call direct reimbursement—to make sure a loyal patient will stay on a high-cost, brand-name drug. The practice of sending checks is legal as long as the patients are not enrolled in government-funded insurance such as Medicare and Medicaid, says health insurance attorney William Schiffbauer. "You can accept cash from anybody as long as it's not a government program," he says, noting there may be income tax obligations for the patient. The federal anti-kickback and Stark laws were meant to prevent bribery of patients and doctors and do not apply to private commercial insurance plans. Harry Totonis, CEO of ConnectiveRx, a pharmaceutical services company, says sending checks to patients is "not a commonly used practice" and happens "a fraction of 1%" of the time. "All of these programs try to help patients afford the medications," says Totonis. Daniel Nam, executive director of federal programs for AHIP, the America's Health Insurance Plans, says direct reimbursement using checks is just another way for manufacturers to make insurance companies pay for expensive drugs, which helps increase monthly premiums. This approach will "create a new black hole of patient-directed payments and avoid any scrutiny," he asserts.