Accumulator adjustment programs lead to surprise out-of-pocket costs and nonadherence, analysis finds

A new analysis by IQVIA looked at three cost-sharing assistance programs and found that from 2018 to 2020, 25% to 36% of patients discontinued treatment when they faced an unexpectedly high out-of-pocket cost of $1,500 or more in the middle of the plan year. These unexpected costs were caused by accumulator adjustment programs operated by pharmacy benefit managers and health plans.

Survey found insurance premiums grew faster than inflation in 2020

According to Kaiser Family Foundation’s recent survey on employer health benefits, premiums for people with employer-sponsored health insurance increased by 4% last year, faster than both the rate of wage growth and inflation. During this same time, prices for brand medicines increased just 1.7% after accounting for rebates and discounts, less than the rate of inflation for the third year in a row.

Study finds middlemen excluded nearly 850 medicines from formularies this year

A new study from Xcenda finds that from 2014 to 2020, the number of medicines excluded by at least one of the three largest pharmacy benefit managers (PBMs) from their standard formularies increased by an average of 34% per year. As a result, each year hundreds of thousands of patients with commercial insurance may not be able to access the treatment prescribed by their doctor.

Manufacturer cost-sharing assistance programs can save chronically ill patients hundreds to thousands of dollars annually

A recent analysis by IQVIA shows that chronically ill patients who used manufacturer cost-sharing assistance in 2019 saved hundreds to thousands of dollars on their out-of-pocket costs. IQVIA found that nearly one-third of commercially insured patients taking brand anticoagulants, diabetes or oncology medicines used manufacturer assistance to help pay their cost sharing for one or more prescriptions, along with more than half of patients taking brand HIV medicines and 70% of patients taking brand multiple sclerosis medicines. For many patients facing high out-of-pocket cost burdens, manufacturer cost-sharing assistance programs are an important source of financial support which can help to improve patient adherence and lead to improved patient outcomes.

Commercial health plans have increased patients’ out-of-pocket costs by over 50% in some therapeutic areas

According to a recent IQVIA analysis, commercial health plans have increased patients’ average out-of-pocket costs for brand medicines by over 50% in some therapeutic areas since 2015. Notably, of the seven therapeutic areas that IQVIA analyzed, including anticoagulants, asthma/COPD, depression, diabetes, HIV, multiple sclerosis and oncology treatments, average patient cost exposure between 2015 and 2019 saw a 32% increase for depression, a 50% increase for HIV and a 56% increase for anticoagulants. Cost exposure represents the level of cost sharing patients would have paid out of pocket if financial assistance, like manufacturer cost-sharing assistance, had not been available.

Commercial health plans’ transition from copays to coinsurance and deductibles has increased patient out-of-pocket costs for brand medicines

A decade ago, most patients paid only copays for brand medicines. But in recent years, use of deductibles and coinsurance in commercial health plans has skyrocketed. According to a recent IQVIA analysis, commercially-insured patients now pay most of their out-of-pocket spending for brand medicines in the form of deductibles and coinsurance. For five of seven therapeutic areas examined by IQVIA, deductible and coinsurance spending accounted for more than two-thirds of patients’ total out-of-pocket spending. For two therapeutic areas, oncology and multiple sclerosis, deductibles and coinsurance accounted for more than 90%.

Four things to know about the IQVIA “Medicine Spending and Affordability in the U.S.” report

Today, IQVIA released a new report, Medicine Spending and Affordability in the U.S., providing context on medicine price and spending trends and patient out-of-pocket costs. The report highlights an alarming trend where health plans increasingly use deductibles and coinsurance to shift more of the cost of care to chronically ill patients taking brand medicines. This is the opposite of how insurance is supposed to work.

New data show commercially insured patients face increasingly high cost sharing for brand medicines

New data show deductibles and coinsurance result in high out-of-pocket spending for commercially insured patients taking brand medicines. IQVIA analyzed trends in cost sharing across seven therapy areas and found that anywhere from 44% to 95% of patients’ total out-of-pocket spending for brand medicines in 2019 was due to deductibles and coinsurance. Compared to patients who only paid copays for brand medicines, patients with deductibles or coinsurance had significantly higher annual out-of-pocket spending across all seven therapeutic areas. In fact, for patients with complex conditions, like cancer and HIV, spending was as much as 25 to 30 times higher.

Payers subject 80% of new RA and MS patients to utilization management restrictions

A new analysis from IQVIA shows that in 2018, 80% of commercially insured patients attempting to fill a new prescription for a rheumatoid arthritis (RA) or multiple sclerosis (MS) medicine encountered a utilization management restriction. Of those patients, 3 out of 10 were unable to gain approval from their commercial market health plan to start new treatments their doctors prescribed for them within 30 days.