Newswise — Eleven provider and patient organizations have joined the American College of Rheumatology (ACR) to petition UnitedHealthcare (UHC) to cancel plans to implement a proposed copay accumulator initiative that would require physicians to share details about their patients’ usage of copay assistance programs. The initiative would prevent funds from assistance programs from being applied towards patients’ annual deductible and out-of-pocket maximums. The groups warn that this would jeopardize patient access to medically necessary therapies by increasing the financial burden of care and lead to an increase in treatment abandonment.
“Rheumatologists treat many patients with chronic conditions like rheumatoid arthritis and lupus that sometimes require using complex biologics to avoid debilitating pain, disability or life-threating complications,” said Chris Phillips, MD, Chair of the ACR’s Insurance Subcommittee. “Unfortunately, biologics are expensive, and for the past few years, insurers have been moving them into ‘specialty tiers’ that require patients to pay a percentage of the actual cost of the drugs. Copay assistance programs thereby preserve patient access to otherwise unaffordable drugs when out-of-pocket expenses are high. The dramatic increase in out-of-pocket expenses will put these treatments out of reach for many patients, potentially leading to disease flares, expensive surgeries, permanent disability, and higher overall health care costs.”
With the annual price of biologic therapies ranging from $22,000 to $44,000, patients who are prescribed biologics on specialty tiers must pay hundreds or thousands of dollars in copayments each month or go without treatment due to prohibitive costs. If copay assistance funds are no longer counted towards deductible and out-of-pocket maximum requirements, patients will have to pay these additional costs. This is particularly concerning for rheumatology patients, because the medications they require are often single-source therapies with no equivalent generic product or therapeutic alternative that is cheaper.
One recent study found that more than one in four specialty brand prescriptions are abandoned during the deductible phase, which is three times higher than the abandonment rate when there is no deductible. These concerns have already led at least four states to prohibit accumulators in individual and small group health plans. The groups also feel that asking physicians to report on the amount their patients receive in copay assistance will put them in an ethically objectionable position.
“Reporting this information knowing that it would likely price a therapy out of reach for a patient who needs it to avoid flares and further disease progression is counter to our oath to first due no harm,” said Phillips. “It would also strain the doctor-patient relationship and would be unethical under AMA guidelines. No one living with a chronic disease should have to choose between their physical and financial health.”
A copy of the group letter to UHC is available on the ACR website at https://www.rheumatology.org/Practice-Quality/Administrative-Support/Insurance-Advocacy/Current-Issues.
The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.