A study released Tuesday showed that Truvada, which is used to treat HIV infection, can also help prevent infection when taken before or after risky gay sex.
Patients can be caught in a dilemma when drug companies and insurers battle over profits, but a recently passed law in Colorado seeks to get patients out of the way, while also giving drug companies a win.
The problem is the medicine coupons that cover the cost of expensive medicines. Over the past few years, more insurance plans have started using “copay accumulators” that don’t count those contributions toward a patient’s deductible.
This means that even if the patient has exhausted all available assistance for the year, they will still have to pay a portion of the cost of the plan until the out-of-pocket limit is reached.
Pharmaceutical companies accuse insurers of being a “double bottom,” while insurers say they are luring patients to more expensive drugs by removing financial pain.
Senate Bill 23-195 requires health insurance plans to include drug coupons, charitable and patient support fund donations in customer deductibles. The bill passed both houses without difficulty, but the office of Gov. Jared Polis has not said if it intends to sign it.
Stacey Hodgson, who has multiple sclerosis, told a Colorado Senate committee to consider the bill in March that the drugs she takes cost about $132,000, out-of-pocket on her recent insurance plan. He said the limit is between $4,000 and $8,000. Without help from the manufacturer, she said, it would be difficult for her to pay these costs and stay on medication.
“People shouldn’t have to choose between medication or, in my case, further brain lesions,” she says.
American Pharmaceutical Researchers and Manufacturers, Pharmaceutical Industry Associations, said in the report Access to patient assistance is particularly common for some high-cost conditions, with more than half of people taking medications to treat HIV and 36% of cancer patients as of 2021 receiving external help. are using the assistance of Reports of patients who used aid for HIV or cancer drugs saved an average of about $1,700 that year.
Carly Tebbatt, regional director of the American Health Plan, said insurers don’t care about genuine philanthropic or personal fundraising efforts like GoFundMe pages.
“The use of copay coupons is another tactic by drug companies to keep prices high,” she testified before a Senate committee. “If patients are worried that they won’t be able to afford the medicine, then lower the price.”
Patrick Boyle, president of the Pharmacy Care Management Association, a trade group, urged lawmakers to distinguish between branded drugs and generic equivalents to incentivize patients to choose the cheaper option. He said the more patients take expensive drugs, the higher the cost for everyone. Lawmakers chose not to include that exception.
Matt Pagnotti, director of state and local government at Vivent Health, said copay accumulator use was a “growing problem” for patients at the center, with about half of the individual insurance plans and at least employers supporting it. He said many plans to do so use accumulators. Vivent specializes in HIV prevention and treatment, and the drugs patients need to keep the virus in check can run into the thousands of dollars a month, he said.
Pagnotti said people with HIV cannot always switch easily to cheaper drugs for reasons such as side effects, viral resistance, or the difficulty of managing multiple pills instead of one a day. Patients typically don’t make decisions based on co-pay assistance, so pushing patients to pay more costs would put their health at risk without saving money for the system, he said.
“I think it’s all about access to care,” he says.
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