Integrated Benefits Institute

June 2017

Rx Benefits Brief: Co-Pay Assistance and High Deductibles

For individuals with complex, chronic conditions like RA, finding the right treatment can be a long and difficult journey. Many are facing high costs due to cost sharing for premiums, deductibles, and Rx out-of-pocket (OOP) amounts. Manufacturers offer commercial co-pay assistance, but there are financial limits to this help. Programs are being offered to reverse application of this assistance from a member’s deductible, but that process can result in a financial burden to members. It has been shown that when some members face higher cost sharing for their medications, they become non-adherent to their therapy. For some patients, medication non-adherence has been associated with increased utilization of costly health care services such as emergency room (ER) visits and hospitalizations. Other strategies exist that can help members stay on treatment as prescribed.

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