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The ongoing battle over high prescription costs is taking another turn. With many specialty prescriptions costing $5,000 per month or more, drug companies figured out by offering pricing assistance until an employee hits the deductible, they could sell a lot of drugs. This created a tremendous challenge for insurers trying to control costs in light of all the direct to consumer advertising.
The latest move by insurers - effectively forces drug companies to pay more to assist patients with their copays - is causing a decline in real US drug prices this year for those companies adopting the strategy and is expected to become more widely adopted in 2019 and beyond.
The good news is this can slow the ever increasing cost of healthcare. The bad news is employees and patients who really need these expensive drugs can find themselves unable to afford them.
Essentially what the "copay accumulator" does is prevents the copay card funds from counting toward a patients out of pocket maximum. Once the out of pocket maximum is reached the insurer pays 100% of the costs and the employee / patient has 100% coverage for all medical and pharmacy costs the rest of the year.
Drugmakers are not taking this in stride and are trying new methods to avoid detection.