This update will apply to UHC’s Advantage and Traditional Prescription Drug Lists, SignatureValue Formulary, and direct business with their proprietary specialty pharmacy, OptumRx. According to UHC, depending on coupon programs, members may be allowed to manually submit a coupon to the manufacturer for rebate.
UHC is working with the pharmacies to inform members of the change and guide them to lower-cost alternatives through point-of-service messaging and ongoing monitoring. This new policy follows UHC’s 2013 program that banned the use of copay coupons in their specialty network for certain tier 3 medications, which proved to be successful in promoting the use of lower-cost medications.
Manufacturers could see a sales decrease as UHC members covered under the specified lines of business may switch to generic products or lower-cost alternatives given the higher cost of branded products. Additionally, manufacturers may consider adjusting patient support programs to help guide patients through the manual rebate submission to encourage ongoing medication adherence.
UHC’s decision also may serve as a bellwether for a market shift in how payers and their associated retail/specialty pharmacies accept copay coupons. While UHC’s actions represent the largest step taken to ban the use of such coupons, they are widely criticized among payers, and others may follow suit.
Hospitals, physician offices and pharmacies likely will face increased administrative burden by having to conduct additional benefit investigations and coverage research to support patients insured by UHC’s member plans that will no longer accept retail copay coupons. Prescribing decisions for these patients must account for increased out-of-pocket costs for patients who previously relied on copay support.
Patients who rely on copay coupon support for affordable access to medication will need to decide whether they will move from current treatment to a lower-cost alternative or face the increased administrative burden of manual adjudication of copay coupons and back-end reimbursement. The latter will likely prompt discussion within the patient access community as advocacy organizations work to find ways to submit initial payment and then be reimbursed by the manufacturer on beneficiaries’ behalf.
All members will receive a letter outlining the new policy by June 1. Throughout May and June, physicians will receive educational resources via the network bulletin eNewsletter, physician letters and physician portals. Point-of-sale messaging at pharmacies will begin in July 1.
View UHC’s full release.