This article is a quickly thrown together position statement vilifying a type of plan sponsor prescription benefit design that utilizes pharmaceutical manufacturer marketing programs to lower employer pharmacy benefit costs.
ASCO calls out several prescription utilization management designs dubbed, "Maximizers" and "Accumulators", as being harmful to patients and time consuming for physician practices to navigate.
Putting aside the poor and partially accurate description of the benefit designs they attack ASCO fails to highlight the blatant conflict of interest when a physician organization attacks a employer (payer) benefit design that, if banned, will only put money back in the pockets of the pharmaceutical manufacturer.
This position statement calls for legislation to prohibit these maximizer and accumulator benefit designs but does not call for changes to prohibit manufacturer copay assistance programs as well. They are calling for the federal government to step in and ban this type of design, the very organization that has banned copay assistance programs from their own health benefit plans (Medicare and Medicaid). It's well documented these programs are manufacturer marketing tools with clear ROI for the manufacturer but does ASCO point out the benefits to their constituents as well? Why is that?
When a manufacturer funds a patient's prescription drug copayment and those funds accumulate toward a patient's deductible and out-of-pocket maximum the manufacturer is, in essence, subsidizing all remaining medical costs for that patient. This includes all physician office visits, medical procedures, copayments for other medications (not funded by the brand program), infusion therapy visits and the list goes on. The amount of manufacturer copay assistance is a small fraction of the total medication cost paid by the plan sponsor or employer. Of course the author advocates for this when they are relieved of the burden of collecting copayments or dealing with bad debt because their patient is having their medical care subsidized by a manufacturer.
Yes, it is extremely unfortunate that a patient on medication funded by patient assistance programs is required to take that medication to sustain or improve their health but does that make it acceptable? How about the coworker with a serious illness that isn't eligible for such a subsidy? They pay the full amount required by their benefit while others within their benefit plan (utilizing drug copay coupons) pay essentially nothing beyond their monthly premium. The employer or plan sponsor ends up paying the rest after the manufacturer support money runs out.
To be transparent, this position statement should have included the following list of donors with affiliations to the pharmaceutical industry. This does not include foundations and other organizations that support ASCO but are indirectly funded by the Industry.
ASCO has passed on an opportunity to address the real issue of affordability within the healthcare supply chain and went right for the topic that transfers money from the employer directly to their donors.
List of Pharmaceutical Manufacturer Donors to ASCO (American Society of Clinical Oncology)
AbbVie Oncology
AbbVie, Inc.
Aduro Biotech, Inc.
Agios Pharmaceuticals, Inc.
Amgen
Arcus Biosciences
Array BioPharma Inc.
Astellas
AstraZeneca
Atara Biotherapeutics
Bayer HealthCare Pharmaceuticals Inc.
Boehringer Ingelheim Pharmaceuticals, Inc.
Bristol-Myers Squibb
Bristol-Myers Squibb Foundation
Celgene Corporation
Chesapeake Biotech Partners, LLC
Clovis Oncology
Daiichi Sankyo, Inc.
Deciphera Pharmaceuticals, Inc.
Eagle Pharmaceuticals
Eisai Inc.
EMD Serono Inc.
Exelixis, Inc.
Ferring Pharmaceuticals, Inc.
Genentech BioOncologyâ„¢
Genmab US, Inc.
Gilead Sciences, Inc.
GlaxoSmithKline Foundation
GRAIL, Inc. GlaxoSmithKline Oncology
HalioDx - Luminy Biotech Enterprises
Halozyme Therapeutics
Incyte Corporation Matching Gifts Program
Iovance Biotherapeutics, Inc.
Janssen Oncology
Janssen Research & Development, LLC
Janssen Scientific Affairs, LLC
Johnson & Johnson Matching Gifts Program
Lilly
Loxo Oncology Inc., a wholly owned subsidiary of Eli Lilly and Company
Merck & Co., Inc.
Merck Foundation
Merck KGaA Darmstadt, Germany
Estate of Mike Miller
Mirati Therapeutics, Inc
Mylan
Novartis Corporation
Novartis Oncology
Novocure
Nuventra
Organon
Pfizer Oncology
Pharmacyclics LLC, an AbbVie Company and Janssen Biotech, Inc
PharmaMar
Regeneron Pharmaceuticals, Inc.
Rigel Pharmaceuticals, Inc.
Roche
Sandoz Inc. (a Novartis Company)
Sanofi Genzyme
Seagen Inc.
Seattle Genetics
Spectrum Pharmaceuticals
Syndax Pharmaceuticals, Inc.
TAIHO Oncology, Inc.
TESARO, a GSK Company
YourCause, LLC Trustee for AbbVie Employee Engagement Fund
YourCause, LLC Trustee for Pfizer Annual Giving Campaign
YourCause, LLC Trustee for Pfizer Foundation Matching Gifts
Zai Lab