Co-Pay Assistance: Insurance companies attack Patient Assistance Programs

Patient Assistance Programs provide access to life-saving treatments

Every year, millions of patients rely on patient assistance programs to gain access to life-saving treatments.

What are patient assistance programs? If a patient can’t afford to pay their insurance co-pay, non-profit organizations step in and provide direct financial assistance to patients in need.

In many cases, drug companies themselves support patient assistance programs as a way to provide access for those who can’t afford ever-increasing insurance co-pays. The programs, according to, “provide a safety net for patients with the greatest financial need to ensure they could have access to life-saving medications. That sense of compassion still undergirds the efforts of many programs.”

These programs are sizable. USA Today reported earlier this year that “100 million prescriptions are filled each year with co-pay coupons.” The Partnership for Prescription Assistance says that “nearly 10 million patients get access to patient assistance programs.”

From our perspective, patient assistance programs are a valuable tool that helps every patient get access to the treatment prescribed by their doctor — no matter how high their insurance premiums.

Insurance Industry Renews Its Attack on Patient Assistance Programs

Of course, no good deed goes unpunished.

Insurance companies and their allies have long targeted patient assistance programs, which they see as an impediment to higher profits. Increasingly, interest groups are targeting patient assistance programs as part of their effort to impose price controls and value frameworks. The latest agenda-driven campaign is being advocated by Peter A. Ubel, MD; and Peter B. Bach, MD.

You probably recognize that last author. Peter Bach is the cost-guru and director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes, who wants his flawed “Drug Abacus” tool to replace doctors in deciding every patient’s treatment.

“Co-pay assistance programs reduce public outcry over outrageous drug prices,” the pair write in The Annals of Internal Medicine. “but, co-pay assistance programs act as an artificial price support, which lessens the incentive for consumers to factor cost into their decisions and further weakens the pressure on pharmaceutical companies to lower the price of their product.”

Notice Peter Bach’s priorities: public outcry trumps patients getting help.

Limiting co-pay assistance is against medicine’s tradition of benevolence

Thankfully, a pair of patient advocates have refuted the latest attack on patient assistance programs.

In a piece at LinkedIn, Dr. Robert Goldberg, vice-president of the Center for Medicine in the Public Interest, and Dr. Rafael Fonseca, the Getz family professor of cancer, chair of the department of medicine and distinguished Mayo investigator at Mayo Clinic in Phoenix, argue that laws that ban co-pay assistance are unethical.

“To create a disincentive as this for people facing serious medical illness appears to me as a fundamental violation of medicine’s stance of benevolence,” they write in a piece published at LinkedIn. “Rather this has the appeal of altruism, sacrifice the few for the benefit of the many.”

“Lastly, government regulations that eliminate this co-pay assistance are demonstrably patient unfriendly. Commercially insured patients can receive this directly and in another study by Dusetzina she shows that the average co-pay for specialty medications is only $35 (5). In another study it was shown that 90% of myeloma patients pay less than $100 per month for lenalidomide, a backbone for the treatment of this disease.”

Check out the entire piece here.

Quote of the Day: Insurance Companies Use Co-Pays to Steer Patients to Different Drugs

“Insurers use co-pays to steer customers to different drugs,” Matt Schmitt, a professor of strategy at UCLA, admitted to Business Insider. He recently co-authored a piece in the New England Journal of Medicine attacking patient assistance programs.

Spotlight on the Marketplace Access Project

Should patients be legally banned from receiving financial assistance to pay their insurance premiums?

As further evidence of how convoluted our health care policies have become, federal regulations currently ban non-profits from supporting premium assistance programs. In March 2014, the Centers for Medicare & Medicaid Services’ federal guidance on third-party insurance payments excluded non-profits from the list of acceptable premium assistance.

Enter the Marketplace Access Project — a patient advocacy movement working to correct this absurd ruling.

“Individuals living with chronic and life-threatening illnesses, such as cancer, autoimmune diseases, and bleeding conditions, rely on patient assistance programs to help cover the high costs of managing their conditions,” the Marketplace Access Project explains on its website. “For the chronically ill and patients suffering from rare diseases, the costs to simply maintain their health insurance can be prohibitive. Premium assistance programs provide a critical service that can mean the difference between life and death for many of these patients – and at no added cost to the public.”

Patients in 37 states are now battling insurance companies. Insurers are citing this rule as they deny coverage to patients. Rather than wait for the issue to make its way through the courts, the best solution is to pass HR 3742 — the Access to Marketplace Insurance Act. If approved by Congress, the law “would override the CMS guidance on third-party payments and require health insurance companies to accept payments from non-profit organizations that operate in compliance with the False Claims Act.”

If you want to help ensure that patients have access to vital premium assistance, check out the Marketplace Access Project.

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