Co-pay Discount Cards = Poor Value

At least in most cases.  Express Scripts recently dropped 48 brand-name drugs from their preferred formulary.  The drug companies offer co-pay cards for 93% of them.  You should consider asking your PBM for their approach to these same drugs.

Here's a link to a list of co-pay cards and coupons.  If you see a drug on this list it likely means it is unnecessarily expensive.

Coupons in Part D Programs?

Here's the link to the Drug Channels post on coupons in Part D programs.  Does the CBO now support co-pay cards for Medicare Part D?  They're current banned by they way.  Here's my favorite bit of information:

"For a specialty drug, the average monthly cost per prescription is usually $2,000 to $3,000, so cost sharing can create an enormous financial burden for seniors. To help patients afford these out-of-pocket expenses, pharmaceutical manufacturers offer co-pay offset programs that cover the patient’s portion. Per A New Reality Check on Co- Pay Offset Programs, nearly 70% of biological drugs have co-pay programs, compared with only 44% of traditional brand-name drugs."

I noted my general concerns about coupon programs in the prior post.  Coupons usually exist only for unnecessarily expensive medications where the manufacturer wants to counter the benefit design and formulary management of the payers.

"And then she presented this card"

NPR reports on the use of drug company coupons to subsidize the cost of brand drug co-payments.  But what's the big deal if the drug company makes up the difference between their drug and the generic alternative?  Here's the payments for the Solodyn example:

Patient:  $10
Drug company (Medicis):  $154.28
Insurance:  $462.84 (est.)

Most of the insurance payment goes back to the drug company.  They probably made over $300 for a one-month supply of a once-daily version of generic minocycline (~$40).  But my favorite part of the story was when the doctor didn't offer the savings card until AFTER the patient complained about the price.  How many people get to pay the $154 or even the full price?

Some plans now use reference pricing to counter these efforts.  This requires the patient to pay the full amount above what the insurance would have paid for the higher value alternative.  Another method would require the patient to pay the full amount up front, like indemnity insurance, then get reimbursed for the covered amount.  This helps patients understand the true costs of their treatment.

What do you get for an extra $600 per month?  Because Solodyn results in lower blood lets it MAY cause less vestibular effects (e.g., dizziness, tinnitus).  Maybe that extra money will go towards a direct comparison to prove that possibility.