The Role of Copay Cards in Healthcare Savings

Copay cards have become a valuable tool for individuals looking to save on out-of-pocket healthcare expenses.

On average, a copay card can reduce out-of-pocket costs by 50% or more.

Many pharmaceutical companies offer copay cards to help make their medications more affordable for patients.

By using a copay card, patients can save hundreds or even thousands of dollars per year on their medications.

Copay cards are a type of financial assistance provided by medication manufacturers to help offset out-of-pocket costs.

These cards can be a huge help for people who struggle with the rising costs of prescription medications, which have increased by 25% in recent years.

Manufacturer copay cards offer financial assistance in the form of copayment, which can be used at a pharmacy to cover part or all of the out-of-pocket cost of a prescription medication.

The medication manufacturers provide the copay cards and determine the maximum amount they will cover for each medication individually.

Copay cards can only be used for brand-name drugs, not generic alternatives, and a person may use them to help lower the costs of more expensive medications.

The good news is that copay cards can be used alongside private insurance, making them a useful tool for people who need help affording their medications.

You can use copay cards to help lower the costs of expensive brand-name prescription medications.

The Advancing Access co-pay program is an example of a copay card that may help patients with commercial or private insurance save on co-pays for certain medications, such as SUNLENCA.

Patients with state or federally funded prescription drug programs, like Medicare or Medicaid, are not eligible for the Advancing Access co-pay program.

Manufacturer copay cards are provided by medication manufacturers to help offset out-of-pocket costs for prescription medications.

These cards are like coupons that patients can use at a pharmacy to cover part or all of the out-of-pocket cost of a prescription medication.

Some copay cards may not cover generic alternative medications, only brand-name ones.

To use the Advancing Access co-pay program, you'll need to call 1-800-226-2056 for support.

Copay cards can significantly disrupt the plan designs that employers take great care to create for their employees.

This is because copay cards can offset the entire cost of a prescription, reducing the monthly copay to zero, which is not the intention of the plan design.

Plan sponsors who utilize high deductible health plans (HDHPs) are also affected, as copay cards can pay the entire deductible amount, effectively reversing the cost incentives built-in to the HDHP design.

This raises questions of fairness, as employees who take specific drugs may get better coverage than their coworkers who do not take those drugs.

Plan sponsors are left in an uncomfortable position, wondering how to ensure that all employees get the same coverage if they pay the same premium.

Critics of copay cards also argue that they may drive up health system costs and lead to higher costs over time.

Restrictions can be a bit tricky to navigate when it comes to copay cards. Some people may not be eligible to get or use them due to government health insurance.

For instance, if you have Medicare or Medicaid, you won't be able to get a copay card. This is because of anti-kickback statutes that prevent manufacturers from offering to cover costs when the federal government may reimburse those costs.

Some areas have laws restricting the use of copay cards, like California. In California, you can't use copay cards to cover the costs of brand-name medications if generic versions are available.

Plan sponsors face a significant challenge when it comes to copay assistance. Employers take great care to design prescription drug plans that meet the needs of their employees and their business.

Copay assistance can disrupt plan designs by offsetting copays, effectively reducing them to zero. This is not the intention of the plan design. For example, a specialty drug that costs $4,000 per month with a $100 monthly copay would have the copay card offset the entire amount.

Plan sponsors who utilize high deductible health plans (HDHPs) are also affected. If a plan has a $2,000 deductible and a copay card pays the $2,000 cost share, the deductible would be met immediately.

This can create a sense of unfairness among plan members. If each member pays the same premium, they should get the same coverage. But copay assistance only applies to members who take specific drugs.

Plan sponsors are put in an uncomfortable position because it doesn't seem right that one member can meet their deductible "for free" using a copay card, while their co-worker has to spend their own money to meet the same deductible.

Here are some key things to consider:

Critics of copay cards argue that they may drive up health system costs and lead to higher costs over time. Some studies have found that copay cards can help reduce the financial burden of out-of-pocket costs for individuals.

Copay programs may lead to higher costs for insurers, who may have to take on greater expenses. This could put a strain on the healthcare system, making it more challenging for everyone involved.

Research has shown that copay cards did not affect demand for specific medications in a large health system, which is a positive finding. This suggests that copay cards may not be the culprit behind increased healthcare costs.

However, some believe that copay cards may lead to an increase in the demand for expensive drugs and could encourage the misuse or overuse of certain medications. This is a concern that needs to be carefully considered.

The future outlook for copay cards is uncertain, but there are some potential regulations that could affect how they're used. New federal price transparency rules took effect in 2023, requiring health plans to disclose the use of accumulator adjustments to members.

Health plans will now be more transparent about their copay card practices, which could lead to changes in how they're used. This could be a positive step for patients, but it's too early to tell.

Five states have already imposed laws prohibiting health plans from using manufacturer assistance, which could set a precedent for other states to follow. We may see increased state legislation to curb the use of accumulators and maximizers.

Here are some key regulations to keep an eye on: