Employers, Insurers Use Patient Assistance Programs To Offset Their Own Costs
Rx patient assistance programs become a de facto stop loss policy (and lucrative boon for third party intermediaries facilitating the process). Add in IRC 501r for good measure and a plan can cut costs back to 1980’s levels. Then add in DPC, controlled referrals, and cash pay and you’ve freed up so much money you can buy each employee a Cadillac for Xmas plus a week’s vacation in Tahiti. Life is good.
“In one approach, insurers or employers continue to cover the drugs but designate them as “nonessential,” which allows the health plans to bypass annual limits set by the Affordable Care Act on how much patients can pay in out-of-pocket costs for drugs.”
“In the other approach, employers don’t bother naming drugs nonessential; they simply drop coverage for specific drugs or classes of drugs. Then, the outside vendor helps patients provide the financial and other information needed to apply for free medication from drugmakers through charity programs intended for uninsured patients.”