Kip Burgess was relieved last year when pharmaceutical giant Amgen overnighted him a $2,976 check to help pay for his go-to arthritis drug, Enbrel. The 36-year-old psychologist had run into an increasingly common problem: The copay coupon sent by Amgen couldn’t cover the drug’s more than $4,000 monthly price.
“Nothing in the world gives me more anxiety than just getting my medication,” Burgess said. “There’s nothing you can do but beg.”
Panicked, Burgess had called Amgen and pleaded for help. The drugmaker sent him the check after he provided a credit card statement and an explanation of benefits to prove he bought its drug.
It’s one of the little-known secrets in health care: When financial incentives like copay coupons and debit cards won’t work, pharmaceutical companies sometimes will write a check — what they call direct reimbursement — to make sure a loyal patient will stay on a high-cost, brand-name drug.
Drugmakers began using now-popular copay coupons and other forms of assistance more than a decade ago to help patients pay out-of-pocket costs for medicines, particularly high-cost specialty drugs such as those that treat autoimmune disorders. The coupons have a dual purpose: They mask the true costs of a drug for patients and give patients a financial incentive to stay on an expensive drug until their insurance deductible is met.
Ellen Albritton, a senior policy analyst with Families USA, said the multiple calls Burgess made to his insurer, pharmacy manager and the drugmaker to pay for his drug is “a lot to put on a patient.”
Read more at Time