What Role do Co-Pay Assistance Programs Play in Payer Decisions?


Luis Torres, MBA, vice president, Managed Care, BioPlus Specialty Pharmacy, discusses the importance of co-pay assistance programs for costly specialty drugs.

It’s actually—it’s become now more mainstream and more commonplace…I was just at a conference last week centered on just that very topic: patient assistance programs and co-pay assistance programs. There’s obviously a delineation between the co-pay assistance program, which is manufacturer sponsored, and then obviously a patient assistance program which is dealing with more hardship, and things of that nature. One of the examples I typically give, is number one drug in the world HUMIRA, is in every payers portfolio, usually on the very top of the list. I’ve seen numbers as high as 28% of their utilization is about between HUMIRA and EMBRIL. HUMIRA is actually a medication that has the first two fills up to $6500 available of co-pay assistance, and then the subsequent months up to 9 months, $800 available, and the payers are saying where should I be placing that drug, not just from a coverage perspective, but where should I place it from a tier perspective, so I can then basically leverage and maximize the available co-pay assistance dollars? Because at the end of the day some payers are looking and examining their coverage portfolios and determining up to what dollar amount can I possibly cover medications overall, and do I establish a gap that also pertains to that coverage?

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