Many patients today experience sticker shock at the pharmacy when picking up their prescribed medications. According to a recent healthcare insights study, 62 percent of patients reported being concerned about the costs of their medications.
While some patients look for affordability options on their own, many don’t know help is there. In our 2021 patient survey, for example, 37 percent were unaware drug-manufacturer financial-assistance programs even existed. And when patients don’t know help is available and they’re concerned about the affordability of their medications, it can result in prescription abandonment at the pharmacy.
Providers and pharmacists can help enable patients to be successful in their therapy regime by making patients aware of and giving them access to manufacturer copay cards.
The first article in this series, “Finding Prescription Affordability Options Amid a Flood of Cards,” gave an overview of different affordability options, including manufacturer copay cards, discount cards and real-time tools delivered within the pharmacy and provider workflow that can help with making informed decisions about affordability.
Here, we’ll focus on how pharmacists and providers can help ease affordability concerns by making their patients aware of manufacturer copay cards.
What are manufacturer copay cards?
Also referred to as discount cards, copay savings programs and copay assistance programs, biopharma copay cards are issued by drug manufacturers directly to patients to help them afford medications by lowering their out-of-pocket costs.
When presented at the pharmacy, copay cards can drastically reduce or even eliminate the cost of high-priced medications and help ensure patients leave the pharmacy with the product they need.
How do copay cards work?
When patients use a copay card at the pharmacy, their health insurance pays the initial prescription cost as normal and returns the patient’s out-of-pocket responsibility. From there, the biopharma company covers all or a portion of the medication cost, which at the pharmacy counter may reduce or eliminate out-of-pocket costs for the patient.
Copay cards help all commercially eligible patients with affordability issues, but they can be especially impactful for those who need expensive specialty drugs to treat their condition.
Although they help lower the costs of prescription drugs, which is good for patients, copay cards are not without controversy.
One common criticism is that brand-name products are higher in cost than equivalent generic drugs, which is why, in most cases, brands with generic availability do not typically offer copay discounts.
According to one study, 79 percent of brand-name drugs had no generic equivalent, which makes copay cards a boon for patients who need help affording these drugs for treatment.
Despite these potential patient affordability advantages, public insurance plans like Medicare and Medicaid prohibit the use of copay cards.
By educating patients on affordability options like manufacturer copay cards, providers and pharmacists can make it easier for patients to get the medicine they need to live healthy lives.
How can you help patients get the most out of copay cards?
Patients who know about biopharma copay cards can find them through the brand or manufacturers’ website. Unfortunately, many patients are unaware of this option or other options to access copay savings.
This is where providers and pharmacists can help. By educating patients on affordability options like manufacturer copay cards, they can make it easier for patients to get the medicine they need to live healthy lives.
A recent survey of providers revealed that most conversations about medication affordability (61.5 percent) were brought up by the patient. When providers initiate these conversations during an office visit, they can help make the process of getting necessary medications faster and, in many cases, more affordable. These affordability conversations are important in establishing the foundation of therapy initiation and provide an acknowledgment from providers that even though potentially costly, the medication is necessary – and the ability to link their patients to copay assistance provides an opportunity to support that patient in their journey.
While many patients are taking medication affordability issues into their own hands, it’s important to know affordability is just one component of the patients’ adherence journey. In addition to saving them money on prescriptions, biopharma copay programs can engage patients and provide education opportunities that help with adherence, and helps them better understand their medications and how they work to treat their conditions.
Getting education and support to patients can be critically important to their adherence and overall outcomes, and through enablement of copay support programs these additional services can be brought to bear for the patient by the biopharma company. The triangulation of support from providers, pharmacies, and pharma working together in support of the patient helps ensure healthy outcomes and an engaged and motivated patient.
What impact do copay cards have on prescription abandonment at the pharmacy?
Put simply, a lot.
Copay cards can help remove an adherence barrier by lowering or potentially even eliminating the cost of a medication. According to our most recent survey, providers and pharmacists both agreed that most conversations about medication affordability happen at the pharmacy., Increasing healthcare literacy at the pharmacy, including affordability options like copay cards, can help patients better understand available resources.
How do CAAPs affect copay discount cards?
Pharmacy benefit managers (PBMs) launched copay accumulator adjustment programs (CAAPs) to prevent copay card discounts from being applied to patient deductibles. This move can put financial pressure on those with high-deductible plans, by shifting more of the cost burden onto their shoulders — which can affect them in their journey to adherence.
Along with recent legislation, significant market influences will continue to impact manufacturer copay programs, like accumulators and maximizers. Fortunately, technology is available to help accurately identify those patients who may be on accumulators so they can create a financial game plan for accessing and affording their medications.
What role will technology play in helping providers and pharmacists assist patients with affordability and other adherence issues?
Whether it’s in the provider’s office or at the pharmacy, technology solutions are available to help patients negotiate the tangled web of medication affordability. Solutions within workflow can help bring up affordability options at the point of prescribing, so care teams don’t have to waste time searching for alternatives.
Patients get access to affordability solutions and the medications they need quicker.
For more information about how healthcare technology can help you help your patients with prescription affordability issues, education and other factors affecting adherence, please download the CoverMyMeds Healthcare Technology edition of the 2021 Medication Access Report.