I’m on a roll here, agreeing with drug companies on an issue related to affordable medicines access. Last week, I wrote about Gilead’s messaging about remdesivir, the new Covid-19 treatment permitted via FDA’s emergency use authorization: namely that you can’t buy remdesivir online: if you try, you’ll be scammed. Often drug companies lie or pay others to lie about buying drugs online from other countries, but not in that case. This week, I’m agreeing with the Pharmaceutical Researchers and Manufacturers of America (PhRMA) that the Trump administration’s new rule on drug manufacturer co-payment cards is not good for consumers because it will prevent the co-payment from counting toward deductibles, which means higher costs for patients.
If you didn’t know, drug manufacturers blanket medical offices throughout the country with their co-pay cards. These cards are sometimes immensely helpful to patients going to fill a prescription for a brand name drug, particularly when there is no generic substitute. How? Simple: the drug company picks up the tab!
Why would they do that? Humanitarianism? Probably not. Good public relations? Just a little, but that’s not it either. They do it largely because it makes them more money. Here’s an example of how it works. If a co-payment is $50 for a one month supply of Xarelto (a patented, brand name drug) costing the employer $500, and a co-payment for a generic therapeutic alternative of Xarelto, warfarin, is $5, and may cost the employer $20, then the employer and the employee are hyper-motivated to go with warfarin. But what if the manufacturer, in our example, Janssen, says, “Hey, dude, I’ll pick up the $50 tab if you and your provider go with Xarelto instead of that old compound warfarin”? The employee (patient) pays $0 but the employer still pays $500.
Okay, so the above seems like an illegal kickback scheme perpetrated by greedy drug companies. So, how am I agreeing with Janssen and Big Pharma here? Hey, not only does the consumer pay $0, but they also reduce their deductible by $50. That is until the new rule. Employers and insurers now have flexibility to determine whether or not those Big Pharma 50 bucks can go toward a deductible. You can bet they will say hell no.
In STAT’s Pharmalot, Ed Silverman got a quote from PhRMA about this issue. Careful not to gag:
“[UPDATE]: Later, a spokeswoman for the PhRMA trade group wrote us that the rule is ‘unconscionable’ for making it ‘harder for patients to use manufacturer cost-sharing assistance to lower their out-of-pocket costs for medicines.’ And she argued ‘we should not allow health insurers to limit how much cost-sharing assistance can help patients at the pharmacy counter.’”
It may be “unconscionable” for PhRMA to use the word unconscionable, but that doesn’t mean they are wrong…in this case.
History: Consumer advocates have for years slammed pharma co-payment cards, and for good reason. The drug companies not only use them to encourage use of the most expensive treatments without generic substitution (per the Xarelto example above); but also for when there is an available generic substitution! Pfizer advertises like mad on sites like GoodRx about getting “brand name” Lipitor, in a manner that appears to market Pfizer’s superior atorvastatin – Lipitor – as the real deal compared to a lower-quality, somehow unreal generic Lipitor (atorvastatin). And then the cherry on top: Pfizer will help you get real Lipitor for $4 a month, which is less than the generic. This marketing and promotion—and legal kickbackism—inflates the costs in the system.
I argue ad nauseam on these blog pages that we have to do everything we can to help Americans with their pharmacy bills in the face of hellish drug prices, and that of course includes allowing and encouraging safe personal drug importation using the Internet. But it also includes not reducing the benefit of the Big Pharma co-pay coupons to patients. Especially not now when so many more millions of Americans are hurting!Gilead Sciences, remdesivir