Copay Assistance Programs: Part of the Problem?

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Copay assistance programs may be creating larger problems in health care markets.
Copay assistance programs may be creating larger problems in health care markets.

HealthDay News -- Despite offering assistance to individuals who cannot afford expensive medications, copay assistance programs create broader problems in health care markets, according to an Ideas and Opinions piece published in the Annals of Internal Medicine.

Noting that Mylan recently offered patients coupons to cover part of their out-of-pocket costs for the EpiPen, Peter A. Ubel, MD, from Duke University in Durham, North Carolina, and Peter B. Bach, MD, from the Memorial Sloan Kettering Cancer Center in New York City, explored the impact of copay assistance for expensive drugs.

The authors report that copay assistance is not a solution to increasing drug costs, but is part of the problem. Copay assistance reduces price pressure by reducing the public outcry over outrageous drug prices. In addition, copay assistance undermines the effect of out-of-pocket expenses on health care utilization, pressuring insurance companies to increase prices and threatening low-cost insurance plans. 

Furthermore, pharmaceutical companies offer assistance for prescriptions that patients fill before their insurance is activated; coupons can be used to speed patients to their out-of-pocket maximum (insurers cannot distinguish between payments from patients and copay coupons). Copay assistance programs also reduce negotiating leverage for insurers and keep patients from acting as consumers who scrutinize the cost and quality of health care services.

"Policymakers should also consider adopting value-based drug pricing as a long-term solution to high copays and thus copay assistance," the researchers wrote.


  1. Ubel PA, Bach PB. Copay assistance for expensive drugs: a helping hand that raises costs. 2016 Oct 11. doi:10.7326/M16-1334 [Epub ahead of print].
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