![]() ![]() With the emergence of consumer-driven pharmacy benefit designs however, which encompass components such as coinsurance and high deductibles, today’s insured members are finding themselves footing a much larger portion of the tab for the price of prescription medications. Such a program would make the most sense when used for essential therapies and for certain patients, particularly those with life-threatening conditions for which there are not reasonable generic substitutes and for patients without health insurance coverage, who would otherwise be unable to pay for the drug’s cost,” Ross says. “The system would operate more efficiently if physicians made sure to only prescribe the lowest cost, highest value drugs for their patients. Second, copay assistance off-set patients’ higher out-of-pocket costs at the time of picking up the prescription, but the insurance company also pays more for the patient to receive that drug, which over time will result in higher premium costs for all patients.”įinally, according to Ross, copay assistance is often time limited, so while patients might be able to use it for their first prescription, or even their third, eventually they will be required to pay the higher out-of-pocket costs for these drugs. But as prices rise, more and more medications are likely to be excluded from formularies. “First, copay assistance can only be used when a patient has insurance coverage and when their insurance plan offers coverage for the drug. “Copay assistance programs do not offer a long-term solution for patients,” Ross says.
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