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Study by PBM Further Highlights Extensive Use of Copay Assistance Programs

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Summary

Prime Therapeutics, America's largest privately held PBM, conducted a study examining member use of cost-sharing assistance programs across a variety of specialty drugs during the first half of 2013.

Results of the study show that copay assistance programs, including manufacturer- and third-party- sponsored cost-sharing assistance programs, offset nearly half of member cost-sharing.

Copay coupons were applied to 40 percent of prescriptions, saving members $835 on average for specialty medications over six months. Members using autoimmune drugs experienced the largest savings, with 73 percent of members’ cost-sharing offset by copay assistance, saving $214 on average per prescription. Moreover, the study found that copay assistance programs were associated with higher numbers of claims involving member cost sharing of up to $150, suggesting that copayment assistance is best suited for specialty therapy drugs with patient cost-sharing around this threshold.

Copay assistance programs can lead to increased access to medications for patients; however, their use often means increased costs to health plans. Of the $417.7 million billed for specialty drugs during the study, $395.8 million was paid for by the plan. Therefore, payers continue to push back on the use of copay coupons as a cost-containment measure. Meanwhile, it is unlikely for manufacturers to discontinue such assistance programs, as it could ultimately cause prescription abandonment.

More insight into the future viability of manufacturer-sponsored copay assistance will become available once the OIG releases its decision on the use of manufacturer-sponsored copay assistance programs in the exchange market.

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