Managed Care Hemo

For patients with complex, chronic conditions like hemophilia, determining the right specialty drug therapy can be a long and difficult journey. Factor replacement products are life-saving specialty drugs with no generic alternatives. Patients with severe hemophilia (FVIII and FIX deficiency) typically infuse factor products prophylactically to prevent bleeding episodes that can lead to progressive morbidity. Maintaining access and promoting adherence for patients is vital to improving outcomes and managing the total cost of health care.

• Prescription abandonment is highest among specialty drugs featuring a deductible as a component of pharmacy coverage
  • Nearly a third of patients abandon prescriptions for specialty drugs when there is a deductible, versus only 9% for prescriptions for traditional pharmaceuticals for plans with no deductible¹
  • In 2016, a significant proportion of patients were enrolled in high-deductible health plans (HDHP), including 50% of those with directly purchased plans and nearly 40% of those with employer-based plans²
• Patients with hemophilia may rely on copay assistance programs to mitigate the financial burden of cost-sharing
  • Currently, copay assistance programs are offered by all manufacturers of clotting factor products and ensure that patients can afford their specialty drug therapies
• Certain plan sponsors have recently begun to use copay accumulator and copay maximization programs that do not count copay assistance from a manufacturer towards a patient’s deductible or out-of-pocket maximum obligations
  • Some managed care decision makers have asserted that copay assistance removes financial incentives for members to choose lower-cost drugs; however, factor replacement products are life-saving therapies with no lower-cost or generic alternatives⁴
  • These copay accumulator and maximization initiatives can negate the benefits of copay assistance programs and reintroduce financial barriers to care for individuals with bleeding disorders

References

1. IMS Health. Medicines Use and Spending in the US: A Review of 2016 and Outlook to 2021. April 2017.

2. Cohen RA, Zammitti EP. High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates From the National Health Interview Survey, 2016. Available at: https://www.cdc.gov/nchs/data/nhis/earlyrelease/ERHDHP_Access_0617.pdf.

3. Dafny LS, et al. N Engl J Med 2016; 375:2013-2015.