The ACR said that the rate of abandonment among specialty prescriptions is 3 times higher during the deductible phase than when there are no deductible requirements, with as many as 1 in 4 specialty drugs being abandoned during this period. If co-payments are unaffordable, patients may have to skip, discontinue, or ration treatment.Īmong some popular rheumatoid arthritis medications, the manufacturers for Humira (adalimumab), Enbrel (etanercept) Rinvoq (upcacitinib), and Xeljanz (tofacitinib), all offer co-pay cards to patients however, none of these medications have a marketed generic or biosimilar version available in the United States.Īccording to a 2019 study published in The American Journal of Managed Care®, nearly 70% of the 132 highest spend prescriptions drugs in 2014 offered co-pay assistance programs. Patients who are part of a health plan with specialty tiers may pay hundreds or thousands of dollars in co-payments monthly. “Unfortunately, biologics are expensive, and for the past few years, insurers have been moving them into ‘specialty tiers’ that require patients to pay a percentage of the actual cost of the drugs….The dramatic increase in out-of-pocket expenses will put these treatments out of reach for many patients, potentially leading to disease flares, expensive surgeries, permanent disability, and higher overall health care costs,” Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee, said in a statement.Īccording to the ACR, the average price of biologic therapies can range from $22,000 to $44,000. The subcommittee urged UHC to consider other options for reducing prescription spending that would not harm patient access and health.Ĭo-pay accumulator policies prevent co-pay assistance programs offered by third parties, such as pharmaceutical manufacturers, from being applied towards patients’ deductible and out-of-pocket maximums. UHC’s policy is expected to go into effect on January 1, 2021, according to a letter on current insurance advocacy issues written by the ACR Insurance Subcommittee. The 12 groups warn that UHC’s implementation of the policy would reduce patient access to expensive medically necessary medications, such as biologic drugs, by making it more difficult to afford them, which can lead to interruptions in treatment adherence. Provider and patient organizations have united with the American College of Rheumatology (ACR) to petition UnitedHealthcare (UHC) to cease plans to implement a co-pay accumulator initiative that would ultimately make it harder for patients to afford their medications.
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