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Who Really Benefits From Pharma Patient Assistance Programs?

Just about any time we mention the price of medications for MS, as we did in a post last week, many people comment that they rely on so-called patient assistance programs from drug manufacturers to help pay for their meds.

While each pharma-sponsored patient assistance program differs in its specifics, the basic way such programs work is to help cover some (or most, or sometimes even all) of the patient’s copayment (as determined by their health insurance plan) for the company’s drug.

MS drug prices being what they are, it’s no wonder that most people have to rely on some form of financial assistance. For that reason, I often read of people with multiple sclerosis lauding, thanking, and praising the companies for offering financial assistance so they can stay on the company’s medication.

While I am happy there is some method by which my MS brothers and sisters can remain compliant with their doctors’ prescriptions for these helpful medications, I see the programs far less benevolently.

I see financial assistance programs from pharma as a Band-Aid — and it’s a dirty, infected Band-Aid at that.

The Arithmetic Behind Patient Assistance Programs

Let’s take a look at the math of one of these programs.

We’ll say that MS disease-modifying therapy “drug X” has a wholesale price of $5,000 per month. (I’m not basing this on any one medication, so I’m not calling out any single manufacturer or insurance plan.)

Insurance company “One” negotiates a reduced price of, say, $4,500 a month for drug X (or $54,000 a year), but to get that price from the pharmaceutical company, they have to “encourage” MS patients under their coverage to try drug X as a preferred medication.

Now, let’s say that as a patient, my out-of-pocket cost for drugs like drug X is an eye-popping $500 per month, up to a ceiling of, say, $3,000. That would be six months of paying $500 per month before I reach my out-of-pocket limit, after which the insurance company picks up the whole monthly cost of the drug.

But I can’t afford $500 per month for six months, and I tell my doctor this. He tells me about the drug manufacturer’s patient assistance program, so I call to find out what’s available and whether I qualify.

The manufacturer tells me that they will pay for my copay up to $2,000 — enough to cover my full out-of-pocket costs for four months of the prescription — giving me time to save up that last two months’ worth of copayments before I’ve reached my ceiling.

I think to myself, “Hmm … if I can put away $250 a month for four months, I can have the drug free of charge for the rest of the year.” That makes my actual out-of-pocket cost only $1,000 per year, or about $85 per month.

I can suck it up for a few months at the high rate of $250, then put away $85 a month after that to pay for next year’s prescription. It sounds like a great deal, and I am SO thankful to the drug company for the help.

But who is really being helped?

How the Pharma Company Benefits

By offering you a deep discount on their medication so that you’ll agree to take it, the drug company is using you to get your insurance company to pay it the remaining portion of their agreed-upon recompense, to the tune of $52,000 a year. They take $2,000 from one pocket of their trousers and put it in another pocket, and then the insurance company puts another $52,000 into that same pocket.

At least that’s how it works until next year, when the next drug comes on the market and, contrary to every law of supply and demand, the wholesale price for all of the MS drugs goes up. Then the whole negotiation process starts again, and the “patient” assistance programs become a lifeline, allowing the drug companies to raise prices without it being felt (too harshly) by the people who really need these drugs.

An Unsustainable System

This smoke and mirrors game is one of the reasons that MS drug prices continue to rise, why stock prices for MS pharma continue to rise, and why CEO salaries continue to rise.

It’s not sustainable, and it’s hardly even assistance.

Story Source: The above story is based on materials provided by EVERYDAYHEALTH
Note: Materials may be edited for content and length

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