Accumulating Barriers to Care: Double Jeopardy for US Patients


Paying higher out-of-pocket costs for health care is an ongoing challenge for patients, especially at a time when they are already experiencing a lot of economic hardship caused by the COVID-19 pandemic.

In a column for PharmaBoardroom, Dan Leonard, National Pharmaceutical Council President and CEO, Kimberly Westrich, Vice President of Health Services Research, and Brian Sils, Senior Research Associate, take a look at how a new government rule could cause patients to incur thousands of dollars in extra out-of-pocket costs per year. 

The rule affects how copay accumulator adjustment programs operate. It would give health plans broader discretion in deciding whether direct payment assistance from a biopharmaceutical company to a patient could count toward a patient’s annual deductible and out-of-pocket maximum.

In their column, they take a closer look at data showing how these programs, coupled with step therapy and prior authorization, can make it difficult for patients to access the treatments they need. Altogether, these programs can reduce patients’ adherence to medications and worsen health outcomes.
Instead, they encourage the consideration of policies that improve patients' financial well-being and incentivize high-value patient care, rather than policies that increase patients' financial burden. Read the full column in PharmaBoardroom.