The reason, it turned out, was that patients were using a card distributed by the maker of an expensive antibiotic used to treatacne, sharply reducing their insurance co-payments. With their out-of-pocket costs much lower, consumers had switched from generic alternatives to the more expensive drug.
With drug prices rising and many people out of work, pharmaceutical companies are increasingly helping patients with their co-payments. The use of such co-payment cards and coupons and other types of discounts has more than tripled since mid-2006, according to IMS Health, an information company that tracks the pharmaceutical industry.
Last month, for instance,Pfizerintroduced a new card that can reduce the co-pay on its blockbuster drugLipitorto $4 a month, a savings of up to $50. That brings the out-of-pocket cost in line with what consumers might pay atWal-Martfor a generic version of a competingcholesterol-lowering drug.
Drug companies say the plans help some patients afford medicines that they otherwise could not.
But health insurers and some consumer groups say that in many cases, the coupons are just marketing gimmicks that are leading to an overall increase in health care costs. That is because they circumvent the system of higher co-pays on costlier drugs that insurers use to encourage consumers to use less expensive products.
“The member is somewhat insulated from the cost of the prescription,” said Kevin Slavik, senior director of pharmacy at the Health Care Service Corporation, which runs Blue Cross and Blue Shield plans in Illinois and three other states.“In essence, it drives up the total cost of providing the prescription benefit.”
TheFood and Drug Administration, meanwhile, is studying the effect of the discounts on consumer perceptions, concerned that the coupons will make consumers believe that a drug is safer or better than it really is.
The acne drug that produced higher costs in 2008 for the Albany insurance company was Solodyn, a once-a-day formulation of an antibiotic called minocycline. A month’s supply of Solodyn sells for more than $700 ondrugstore.com, compared with about $40 a month for capsules of generic minocycline, which are generally taken twice a day.
Executives at Medicis, the company that sells Solodyn, have told investors that the co-payment card is used by an“overwhelming majority” of patients, and is largely responsible for doubling use of the drug, to 26,000prescriptionsa week.
Co-payment coupons and cards are distributed by drug company sales representatives to doctors, and are also often available directly to patients over the Internet. Patients present them at the drugstore when paying for their prescriptions.
Any shift to brand-name drugs can have a big impact on health care costs.
AtDistrict Council 37, a union representing public employees in New York City, 59 percent of claims for statins in the year ended in June 2009 were for brand-name products that cost the plan $17.3 million. The other 41 percent of claims were for generic statins, which cost only $179,000. A year ago, the health plan eliminated the co-pay on generic statins to encourage more use of them.
For very expensive drugs, co-pay assistance is almost de rigueur, because in some cases co-payments can be up to 20 percent of the price of the drug.Novartis’s new pill formultiple sclerosis, Gilenya, costs $48,000 a year, compared with $30,000 to $40,000 for rival drugs, which are injected. Novartis is offering to cover the entire co-pay, up to $800 a month, which is 20 percent of the drug’s monthly cost.
“It seems the best strategy for a pharmaceutical company is to price their drug as high as they possibly can and offer that co-pay assistance broadly” to insulate consumers, said Joshua Schimmer, biotechnology analyst at Leerink Swann, an investment bank.
Jazz Pharmaceuticalshas quadrupled the price of itsnarcolepsydrug Xyrem, to about $30,000 a year, over the last five years, according to a recent report from the securities firm Jefferies&Company. To cushion patients, the company recently increased its co-pay assistance to as much as $1,200 a month.
“We do want to avoid big jumps in price, abrupt changes in price, which can have a negative impact on payers, physicians and, most importantly, patients,” Robert M. Myers, Jazz’s president, told analysts in November, as the company increased Xyrem’s price by 22 percent. He added:“The coupon program, I will point out, does help patients get low monthly out-of-pocket costs, and this is a program that we are definitely committed to.”
Drug companies defend the coupons, saying they are helpful to consumers and allow patients and doctors to make decisions based on medical reasons, not costs. In many cases, such as with Lipitor and Solodyn, the rival drugs are not exact generics.
Jonah Shacknai, the chief executive of Medicis, said Solodyn’s once-a-day formulation reduces side effects and makes it easier for people to take their medicine. He also said many insurers paid far less for the drug than the price ondrugstore.com.
“No one is forcing anyone to prescribe Solodyn,” he said.“We think the public wins because we have facilitated access to a product that dermatologists are eager to prescribe.”
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