Many Ohioans lack access to prescription medications because insurers and pharmacy benefit managers are increasingly making it more difficult for patients to afford them. High-deductible health plans, copayments, coinsurance, copay accumulators, restrictive formularies, etc. are all tactics used to simply push more of the cost-share onto the patient.

How a quiet co-pay rule change could mean massive drug cost increases

How a quiet co-pay rule change could mean massive drug cost increases
October 22, 2020

BY TERRY WILCOX AND STACEY WORTHY The COVID-19 pandemic has hit those with chronic diseases especially hard. According to its most recent weekly summary, the Centers for Disease Control and Prevention estimates that 91% of patients hospitalized with the disease have at least one underlying medical condition. Patients with chronic diseases face an additional burden due to a…

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Americans Believe Government Should Require Copay Assistance Be Applied to Out-of-pocket Costs

Americans Believe Government Should Require Copay Assistance Be Applied to Out-of-pocket Costs
October 22, 2020

  The National Hemophilia Foundation (NHF) today released results from a new national online survey of registered voters that illustrates the importance and impact of patient copay assistance programs on patient affordability against the backdrop of the COVID-19 pandemic. The NHF survey, National Registered Voter Sentiment on Patient Copay Assistance Programs, found that 86 percent of…

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Understanding United Healthcare’s Accumulator Policy

Understanding United Healthcare’s Accumulator Policy
October 22, 2020

The following post is from Julie Baak, the Practice Manager for the Arthritis Center in Saint Louis, Missouri and a fierce patient advocate. What is a Copay Accumulator? Copay accumulator programs target the most costly specialty drugs. These drugs often have copay assistance programs in place to help offset costs to patients. A copay assistance program is where…

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PBM Exclusion Lists: Useful For Leverage But Do They Benefit The Patient?

PBM Exclusion Lists: Useful For Leverage But Do They Benefit The Patient?
May 6, 2020

Joshua Cohen forbes.com In January, the two largest pharmacy benefit managers (PBMs) – Express Scripts and CVS Caremark – increased the numbers of drugs on their 2020 exclusion lists. These lists include drugs that a PBM doesn’t recommend covering. PBMs’ clients – the plan sponsors – can choose not to adopt a formulary with exclusions,…

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With Federal Nod, Consumers Could Lose The Boost They Get From Drug ‘Coupons’

With Federal Nod, Consumers Could Lose The Boost They Get From Drug ‘Coupons’
May 6, 2020

Michelle Andrews khn.org Patients who get financial help from drug companies to cover their copayments for prescription drugs could owe a bigger chunk of their costs under a proposed federal rule. The annual rule, which sets a wide range of standards regarding benefits and payments for most health plans for next year, would allow employers…

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Military-health drug problems getting worse, cancer clinics say

Military-health drug problems getting worse, cancer clinics say
March 19, 2020

Community oncology clinics say that the military health system’s exclusive relationship with a giant corporation increasingly is putting them at a disadvantage. And that disadvantage is putting the health of veterans and members of the active-duty military at risk, the clinics say. The Community Oncology Alliance again wrote to the U.S. Department of Defense last…

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NJ limits Rx Drug Expense

NJ limits Rx Drug Expense
March 19, 2020

Governor Murphy Signs Prescription Drug Bill to Limit Out-of-Pocket Prescription Drug Expenses for New Jersey Families TRENTON – Governor Phil Murphy today signed legislation (A2431) to help limit out-of-pocket prescription drug expenses for New Jersey families. The bill, which requires health insurers to provide plans that limit patient cost-sharing concerning prescription drug coverage, will improve…

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NJ Gov signs Rx drug limit bill

NJ Gov signs Rx drug limit bill
February 28, 2020

Governor Murphy Signs Prescription Drug Bill to Limit Out-of-Pocket Prescription Drug Expenses for New Jersey Families TRENTON – Governor Phil Murphy today signed legislation (A2431) to help limit out-of-pocket prescription drug expenses for New Jersey families. The bill, which requires health insurers to provide plans that limit patient cost-sharing concerning prescription drug coverage, will improve…

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