Drugmakers try evasion, tougher negotiations to fight new U.S. insurer tactic

U.S. drug makers are scrambling to limit the economic damage from a new U.S. insurer tactic that effectively forces drug companies to pay more to assist patients with their copays. The move by the insurers is causing a decline in real U.S. drug prices this year, and is expected to become more widely adopted in 2019.

U.S. drug makers are scrambling to limit the economic damage from a new U.S. insurer tactic that effectively forces drug companies to pay more to assist patients with their copays. The move by the insurers is causing a decline in real U.S. drug prices this year, and is expected to become more widely adopted in 2019. In recent years, insurers have tried to guide patients toward less expensive treatments by making them pay a higher portion of a drug’s costs. Drugmakers responded by dramatically raising the financial aid they offer, in the form of "copay assistance" cards that reduce what consumers need to pay when they place their pharmacy order. This year, Express Scripts and others introduced a new "copay accumulator" approach for its corporate customers. The programs prevent copay card funds from counting toward a patient’s required out-of-pocket spending before insurance kicks in on expensive specialty drugs, such as arthritis and HIV treatments. Pharmaceutical firms are responding in various ways, including new payment options to evade detection by the PBMs so that a patient still benefits from the financial aid, says Matthew Turner, who is working with drugmakers as director of patient affordability at TrialCard, which operates copay cards for companies. Drugmakers are also taking a tougher stance when negotiating prices or new discounts for payers, according to insurance industry executives and pharmaceutical consultants.