Bill Would Restrict Co-Pays, Other Cost-Sharing Measures

Co-pays, cost-sharing, coinsurance and other methods used by pharmaceutical companies as an incentive for patients to purchase their drugs would be restricted under a new bipartisan bill introduced in the House of Representatives on 19 March.

H.R. 4209 - Patient's Access to Treatments Act of 2012, introduced by Reps. David McKinley (R-WV), Lois Capps (D-CA), Barney Frank (D-MA), Henry Cuellar (D-TX) and C.W. Bill Young (R-FL), would do away with preferential treatment of brand-name pharmaceutical products.

"A group health plan, or a health insurance issuer offering group or individual health insurance, that provides coverage for prescription drugs and uses a formulary or other tiered cost-sharing structure shall not impose co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier that exceed the dollar amount (or its equivalent) of co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a non-preferred brand drug tier (or prescription drugs in a brand drug tier if there is no non-preferred brand drug tier)," says the bill.

The payments are widely used now, particularly by companies looking to keep generic competition at bay. Some co-payment assistance plans make the brand-name out-of-pocket cost to the consumer lower than it would be for a generic product, thereby influencing the consumer to ask for the brand-name product.

Critics have charged this unnecessarily inflates healthcare spending, while pharmaceutical companies have countered by saying it decreases costs for the patient.

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H.R. 4209 - Patient's Access to Treatments Act of 2012