11 Groups Join ACR in Opposition of UHC’s “Disastrous” Co-Pay Policy

October 30, 2020
Skylar Jeremias

The American College of Rheumatology (ACR) has joined forces with other provider groups to oppose a plan proposed by UnitedHealthcare that would increase patients’ out-of-pocket costs.

Provider and patient organizations have united with the American College of Rheumatology (ACR) to petition UnitedHealthcare (UHC) to cease plans to implement a co-pay accumulator initiative that would ultimately make it harder for patients to afford their medications.

The 12 groups warn that UHC’s implementation of the policy would reduce patient access to expensive medically necessary medications, such as biologic drugs, by making it more difficult to afford them, which can lead to interruptions in treatment adherence.

UHC’s policy is expected to go into effect on January 1, 2021, according to a letter on current insurance advocacy issues written by the ACR Insurance Subcommittee. The subcommittee urged UHC to consider other options for reducing prescription spending that would not harm patient access and health.

Co-pay accumulator policies prevent co-pay assistance programs offered by third parties, such as pharmaceutical manufacturers, from being applied towards patients’ deductible and out-of-pocket maximums.

“Unfortunately, biologics are expensive, and for the past few years, insurers have been moving them into ‘specialty tiers’ that require patients to pay a percentage of the actual cost of the drugs….The dramatic increase in out-of-pocket expenses will put these treatments out of reach for many patients, potentially leading to disease flares, expensive surgeries, permanent disability, and higher overall health care costs,” Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee, said in a statement.

According to the ACR, the average price of biologic therapies can range from $22,000 to $44,000. Patients who are part of a health plan with specialty tiers may pay hundreds or thousands of dollars in co-payments monthly. If co-payments are unaffordable, patients may have to skip, discontinue, or ration treatment.

Among some popular rheumatoid arthritis medications, the manufacturers for Humira (adalimumab), Enbrel (etanercept) Rinvoq (upcacitinib), and Xeljanz (tofacitinib), all offer co-pay cards to patients; however, none of these medications have a marketed generic or biosimilar version available in the United States.

According to a 2019 study published in The American Journal of Managed Care®, nearly 70% of the 132 highest spend prescriptions drugs in 2014 offered co-pay assistance programs.

The ACR said that the rate of abandonment among specialty prescriptions is 3 times higher during the deductible phase than when there are no deductible requirements, with as many as 1 in 4 specialty drugs being abandoned during this period.

So far, concerns over prescription abandonment have led Arizona, Illinois, Virginia, and West Virginia to prohibit co-pay accumulator policies in individual and small group health plans.

Because co-pay accumulator policies require physicians to share details about the usage of co-pay assistance programs, the advocacy groups have concerns over whether these policies will put physicians in morally compromised position.

“Reporting this information knowing that it would likely price a therapy out of reach for a patient who needs it to avoid flares and further disease progression is counter to our oath to first due no harm….It would also strain the doctor-patient relationship and would be unethical under AMA guidelines. No one living with a chronic disease should have to choose between their physical and financial health,” said Phillips.