In this week's Annals of Internal Medicine, doctors Peter A. Ubeland and Peter B. Bach have written an opinion piece entitled Co-pay Assistance for Expensive Drugs: A Helping Hand That Raises Costs. You may remember Dr. Bach from his previous attempts to draw attention to this issue last year. I have written previously about the reality underlying co-payments for both drugs and other therapies. The authors make the following points:
Drug costs are one of the fastest growth components of health care and out of pocket drug costs have kept pace as insurance companies "peel back coverage." As I have suggested, there is an attempt to shift these costs back to the insurer through co-pay coupons. Ubeland and Back feel that co-pay assistance
- diminishes price pressure (by reducing the cost to patient)
- undermines benefit design that allows for low-cost insurance plans
- are not as good as they seem (lasting only through the point where the patient's deductibles have been met, and the insurer again pays full cost)
- reduces the leverage of insurers in controlling price (by maintaining price 'artificially' high)
- keeps patient's from acting like consumers (presumably choosing lower cost equivalent medications)
They recommend means to ensure "equity of access" by
- Providing co-pay assistance to all
- Creating a registry of programs to make them easily identified by patients and physicians, and
- Have pharmacies report copay coupons separately so that insurance companies can exclude these "non-patient payments" to mitigate any reduction in patient co-payments
- Use co-pay assistance in determining a medication's index price for Medicaid and Medicare.
I would disagree with their recommendations because it is building new regulations and restrictions on top of a house of cards - suggestions driven by 'policy' possibility. Certainly, removing the value of co-pay discounts for patients unable to afford them is antithetical to the physician's need to do no harm. Their long-term solution is value-based drug pricing where "the price of the drug would be aligned with its benefit." Value-based pricing is, in reality, the only solution and it is time to allow Medicare and Medicaid to flex their financial muscle as the largest purchasers of medications. It is the market solution.
I congratulate Drs. Ubeland and Bach for continuing to speak up. The prescription of drugs are a valuable tool in our work; we should not let this medication prices be controlled by forces whose primary concern are its stockholders. Our role as physicians is to advocate for our patients; high drug prices lessen our ability to use the drugs our patient's need. It is time for all of us to speak up.