The policy, which was set to begin on July 1, 2014, would have been the first of its kind and has incited much debate since its March 4 announcement. UHC will, however, continue to prohibit the use of copay coupons in their Specialty Pharmacy program for certain tier 3 medications.
Many remain curious why UHC decided to peruse this policy reversal. “While I have not spoken directly with a representative from UHC regarding the plan’s decision, I believe UHC’s reversal on discontinuation of retail copay coupons was most likely motivated by feedback from key stakeholders,” said Avalere Health Senior Vice President, Sandy Robinson. “From the time this was announced many have asked how UHC could enforce the block – both from a transactional/operational and contractual basis. Restricting the use of retail coupons creates a negative experience for both patients and in-network retail pharmacies at the point of sale when a coupon is refused. That encounter creates a ripple effect back to the patient’s doctor (as the prescriber) and potentially to the patient’s employer. There are now four key stakeholders – patients, pharmacies, doctors and employers – who have had a negative experience. I believe that, combined with the mechanics of enforcing the ban, caused UHC to re-think their tactic.”
Moving forward, manufacturers should be prepared for UHC to implement more stringent policies that steer patients towards generic products or lower-cost alternatives. In addition, UHC’s recent change in course may dissuade other payers from implementing similar policies restricting manufacturer-provided retail copay coupons.
UHC will continue to look for “innovative solutions” to control brand drug costs. To that end, future in-network retail pharmacy contracts may reflect this change.
View UHC’s announcement.