ACR urges UnitedHealthcare to cancel new copay proposal
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The American College of Rheumatology and 11 other provider and patient groups have called on UnitedHealthcare to cancel its proposed copay accumulator initiative, arguing it would increase financial burdens and limit access to treatments.
According to the group, United Healthcare will as of Jan. 1 require providers to report the amount their patients receive in copay assistance for office-administered treatments. The insurer will then use this information to enforce a copay accumulator, which would prevent funds from assistance programs from being applied to patients’ annual deductible and out-of-pocket maximums, the ACR said in a press release.
“Rheumatologists treat many patients with chronic conditions like rheumatoid arthritis and lupus that sometimes require using complex biologics to avoid debilitating pain, disability or life-threating complications,” Chris Phillips, MD, chair of the ACR Insurance Subcommittee, said in the release. “Unfortunately, biologics are expensive, and for the past few years, insurers have been moving them into ‘specialty tiers’ that require patients to pay a percentage of the actual cost of the drugs.”
“Copay assistance programs thereby preserve patient access to otherwise unaffordable drugs when out-of-pocket expenses are high,” he added. “The dramatic increase in out-of-pocket expenses will put these treatments out of reach for many patients, potentially leading to disease flares, expensive surgeries, permanent disability and higher overall health care costs.”
According to the ACR, the annual price for biologic therapies ranges from $22,000 to $44,000, with patients on specialty tiers having to pay hundreds or thousands of dollars in copayments each month, or otherwise going without treatment.
If copay assistance funds are no longer counted toward deductible and out-of-pocket maximum requirements, the ACR argued, patients will be forced to pay these additional costs.
“This is particularly concerning for rheumatology patients, because the medications they require are often single-source therapies with no equivalent generic product or therapeutic alternative that is cheaper,” read the ACR release.
In addition, the groups said requiring physicians to report on the amount their patients receive in copay assistance forces them into an ethically objectionable position.
“Reporting this information knowing that it would likely price a therapy out of reach for a patient who needs it to avoid flares and further disease progression is counter to our oath to first due no harm,” Phillips said in the release. “It would also strain the doctor-patient relationship and would be unethical under AMA guidelines. No one living with a chronic disease should have to choose between their physical and financial health.”
The groups expressed these concerns to the insurer in a letter dated Oct. 7 to Lewis G. Sandy, MD, FACP, executive vice president of clinical advancement for UnitedHealth Group.
Other than the ACR, the signatories include the AIDS Institute, the American Academy of Dermatology Association, the American Academy of Neurology, the American College of Gastroenterology, the American Gastroenterological Association, the American Kidney Fund, the Arthritis Foundation, the Association for Clinical Oncology, the Cancer Support Community, the Council of State Rheumatology Organizations and the National Multiple Sclerosis Society.
A spokesperson for United Healthcare did not immediately respond to a request for comment.
According to the ACR, at least four states have prohibited copay accumulators in individual and small group health plans, due to concerns of patients abandoning their prescriptions during the deductible phase.
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