Health plans are increasingly using deductibles and coinsurance to shift more of the cost of care to chronically ill patients who take brand name pharmaceuticals. Despite rebates that are negotiated with pharma to reduce brand medicine prices, most patients who have deductibles and copays do not benefit directly from these savings. Instead, their cost sharing is based on the full undiscounted prices. These results were derived from an IQVIA analysis of the trends in cost sharing across seven therapy areas. From 44% to 95% of patients’ total out-of-pocket spending for brand medicines in 2019 was due to deductibles and coinsurance. Compared to patients who only paid copays for brand medicines, patients with deductibles or coinsurance had significantly higher annual out-of-pocket spending across all seven therapeutic areas. In fact, for patients with complex conditions, like cancer and HIV, spending was as much as 25 to 30 times higher.
Often, biopharmaceutical companies offer cost-sharing assistance to help commercially insured patients afford these skyrocketing out-of-pocket costs. In 2019, cost-sharing assistance saved patients $1600-$2200 on their out-of-pocket costs, on average (IQVIA analysis).
Unfortunately, a recent policy change from the Administration makes it harder for patients to have manufacturer cost-sharing assistance help them at the pharmacy counter. The change allows commercial market health plans to refuse to count cost-sharing assistance toward patient out-of-pocket caps.