Employers Reaping Benefits from Patient Assistance Programs

December 14, 2022

An increasing number of employers are leveraging patient assistance programs intended for patients to help cut spending on employee health plans. These programs, long objected to by many employers, are offered by drugmakers to help cover expensive treatments when a plan deems the treatment nonessential due to cheaper alternatives. This has led to employer plans changing essential status to capitalize on these programs.

According to Julie Appleby, “In one approach, insurers or employers continue to cover the drugs but designate them as “nonessential,” which allows the health plans to bypass annual limits set by the Affordable Care Act on how much patients can pay in out-of-pocket costs for drugs. The employer or hired vendor then raises the copay required of the worker, often sharply, but offers to substantially cut or eliminate that copay if the patient participates in the new effort. Workers who agree enroll in drugmaker financial assistance programs meant to cover the drug copays, and the vendor monitoring the effort aims to capture the maximum amount the drugmaker provides annually, according to a lawsuit filed in May by drugmaker Johnson & Johnson against SaveOnSP, which is based in Elma, New York.”

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(Source: Fierce Healthcare, December 8th, 2022)

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