UnitedHealthcare Bars Copay Coupons for Specialty Drugs


According to a report by Elsevier's Business Intelligence, UnitedHealthcare has announced that pharmacies that are participating in its Designated Specialty Pharmacy network will no longer redeem manufacturer-sponsored coupons.

According to a report by Elsevier’s Business Intelligence, UnitedHealthcare has announced that pharmacies that are participating in its Designated Specialty Pharmacy network will “no longer redeem manufacturer-sponsored coupons as an offset to member cost-sharing payments for 6 specialty drugs beginning January 1, 2013.”

The new policy is one that affects drugs with lower-priced competition. According to an update on the insurers’ intra-organizational plan manager website in late August, the move is being made as an effort to create a financial incentive for members that participate in the aforementioned Designated Specialty Pharmacy Program. The goal is to get these members to choose a lower-tier, lower-cost drug alternative. The insurer is hoping that the result of the move is to decrease the current rate of 45% of their members opting for higher-cost medications despite alternatives.

The targeted drugs include the following:

  • Extavia (Novartis; multiple sclerosis)
  • Gilenya (Novartis; multiple sclerosis)
  • Cellcept (Roche; transplant patients)
  • Humira (Abbott Laboratories, Inc; rheumatoid arthritis, Crohn’s disease, and psoriasis)
  • Victrelis (Merck; hepatitis C)
  • PegIntron (Merck; hepatitis C)

According to the announcement by UnitedHealthcare, the move is expected to impact a very small amount of its members; in fact, the company stated that “less than 0.1% of members take an impacted drug.” The company adds that the new policy is “modeled on the federal government’s long-time practice of not allowing coupons to be redeemed for patients covered by Medicare, Medicaid, and other federal healthcare programs,” and that it’s “common practice for mail-order facilities not to facilitate redemption of manufacturer coupons for non-specialty medications.”

According to the report by Elsevier, payers generally feel as though copay assistance programs unnecessarily increase costs and, subsequently, hurt consumers. In addition, the report adds, these programs “circumvent the formulary-tiering system and result in fewer drug rebates being passed along to plans because manufacturers no longer need to offer such concessions to gain preferred brand, or tier-2, status.”

Despite these consequences, the Pharmaceutical Care Management Association is estimating that copay assistance programs will increase by 15% over the next 10 years, which indicates that drug firms continue to sponsor programs at a growing rate.

SOURCE: The American Journal of Managed Care

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