Sebelius Confirms Drug Manufacturers Can Help Pay Patient Out-of-Pocket Expenses

Sebelius Confirms Drug Manufacturers Can Help Pay Patient Out-of-Pocket Expenses | Pintas & Mullins Law Firm

As part of the new provisions for the Affordable Care Act (aka Obamacare), the Department of Health and Human Services (HHS) recently ruled that drug manufacturers will be able to help pay for many patients’ branded drug expenses. The decision, lauded by Big Pharma but criticized by health plans, clarifies the extent to which drug companies may help pay for co-payments. Dangerous drug lawyers at Pintas & Mullins Law Firm are anxious to see how this new rule will affect the health and safety of patients nationwide.

Federal law currently forbids drug manufacturers from assisting Medicare and Medicaid patients in out-of-pocket prescription payments. The Secretary of HHS, Kathleen Sebelius (pictured), affirmed that this prohibition no longer applied to insurance companies that participate in the new online health exchanges because they are not federal health programs. It is still illegal, however, for Medicare and Medicaid patients to receive co-payment assistance.

How this Affects the Average Patient

This clarification paves the way for pharmaceutical companies to steer patients toward buying higher-cost brand-name drugs instead of generics. Until Sebelius’ announcement, it was largely unclear whether or not patients applying for federal subsidies through the new online marketplaces could also receive co-payment assistance by drug makers. It is now affirmed that they can, as long as they are not enrolled in Medicare or Medicaid.

Health plans and pharmacy-benefit managers have voiced skepticism over the issue, believing that it will cause higher premiums and increased cost-sharing for patients. The Pharmaceutical Care Management Association is planning to challenge the HHS decision in the ensuing months. Conversely, a spokesperson for GlaxoSmithKline stated that the decision appears to be beneficial for patients, as it will provide a service for patients who need help paying out-of-pocket prescription costs.

In 2011, drug manufacturers like GlaxoSmithKline spent about $4 billion on co-payment assistance programs in the U.S., and are currently contributed up to $90 billion in fees, discounts and other services under the new healthcare system. To make up for these costs, Big Pharma is expecting patients to increase drug spending as more and more Americans sign up for health insurance.

How this Affects the High-Needs Patient

For patients with chronic or particularly serious ailments, such as multiple sclerosis or cancer, this program is much-welcomed. Co-payments for these patients add up very quickly and assistance is often direly needed, as it can mean the difference between properly taking medications and not being able to even fill prescriptions.

Some patients may be familiar with copay cards, which operate much like debit or credit cards and can be used when filling prescriptions. Copay cards are usually associated with one brand name, such as Bayer or Pfizer, and can cover much of the co-payment, making the cost equivalent to that of generic versions. 

While these cards do benefit patients who need to take high-cost medications for chronic illnesses (a psoriasis patients often pays upwards of $2,500 a month for Humira), many assert that the increased reliance on them will increase spending on prescription drugs overall. There are currently two lawsuits pending against HHS by union health insurance plans and individual plaintiffs, which aim to block copay cards.

Drug recall lawyers at Pintas & Mullins Law Firm will continue to report on updates relating to the Affordable Care Act as they relate to the American patient. If you or a loved one was seriously injured by a prescription drug, our experienced team of pharmaceutical attorneys can explain to you your legal rights. We offer free, no-obligation legal evaluations to potential clients nationwide.