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Patient advocates, drug companies hope to block insurers from lowering drug costs

AHIP to push back against groups' efforts

Patient advocate groups, supported by drug companies, hope to put a damper on insurers' efforts to lower rising drug costs, reported Bloomberg.

A campaign called Cap the Copay, which is financed by Pfizer and other pharmaceutical companies, is pushing for state laws that require insurers cover most drug costs by limiting the amount they can charge members each month.

So far, the patient and pharmaceutical groups are making progress--four states adopted such laws last year and at least nine other states are considering similar legislation, noted the article. 

Pfizer said it supports Cap for Copay because insurers shouldn't be allowed to discourage sick people from enrolling. "We believe insurers should not discriminate against any patient based on disease or disability," Pfizer spokeswoman Sharon Castillo told Bloomberg.

But that flies in the face of insurers' efforts to prevent drug costs from continuing to increase. Many insurers, for example, are adopting more cost-sharing measures like coinsurance to shift the costs of expensive specialty drugs onto consumers, FierceHealthPayer previously reported.

That's in part because specialty drugs like Sovaldi, which is used to treat hepatitis C, made up 32 percent of health plan drug spending last year. And consumers enrolled in health insurance exchange plans are 59 percent more likely to use pricey specialty drugs than people with employer-based coverage.

What's more, America's Health Insurance Plans (AHIP) says that even when insurers require members to pay large up-front costs, the companies still cover more than 90 percent of specialty drugs, Bloomberg noted.

To help prevent insurers from absorbing these drug costs, AHIP is pushing back against Cap for Copay's efforts. "Proposals that place a cap on prescription drug coverage without addressing the price side, what's charged for the drug, will only drive costs higher for patients, and for state governments, and for employers," AHIP CEO Karen Ignagni told Bloomberg. "It's a shell game that's being played on consumers."

AHIP has already made some progress by claiming victory in defeating recently proposed copay legislation in Virginia and Mississippi.

To learn more:
- read the Bloomberg article

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Insurers increase cost-sharing measures for specialty drugs
Benefits plans excluding more drugs as costs rise
Insurers figure out ways to cover pricey treatments
60 Minutes spotlights rising drug costs