Out-of-pocket expenses for patients are a hot topic and the rules of the road for whose out-of-pocket costs can be covered is the subject of a current lawsuit in federal courts. Pfizer filed the lawsuit challenging federal anti-kickback laws in Medicare to allow manufacturers to pay or provide some offset to a patient’s copays. Currently the Medicare program does not allow for manufacturer coupons or offsets and the Office of Inspector General argues that this is one of the remaining hurdles to slow rising drug prices. Pfizer says as a manufacturer they have the right to fund (via coupons, copay programs, or private charity) any patient.
Discern and Real Chemistry recognize that out-of-pocket and affordability issues for patients play a role in a person’s ability to access their medication and to adhere to the treatment plan as prescribed, which can significantly impact clinical outcomes. This is one reason healthcare providers are reluctant to agree to clinical outcomes as measures of their performance in value-based programs. Issues of adherence, access, and affordability are of pivotal importance as the broader healthcare system shifts to a system that rewards value over volume.