Massive rise in out-of-pocket branded drug costs for US patients with a deductible

Spending on medicines is growing at the slowest rate in years, but according to a new IQVIA Institute for Human Data Science article, at the pharmacy, commercially insured patients with a deductible have their seen out-of-pocket costs for brand medicines increase 50% since 2014, according to a web posting by trade group American Pharmaceutical and Research Manufacturers.

The data also show 55% of patients’ out-of-pocket spending on brand medicines in 2017 was for prescriptions filled in the deductible or with co-insurance rather than with a fixed co-pay, notes Holly Campbell, a deputy vice president of public affairs at PhRMA focusing on the cost and value of medicines. This share has increased 20% since 2013 as insurers are increasingly shifting more and more of the costs of medicines to patients.

Even though rebates paid by biopharmaceutical companies often substantially reduce what insurers and pharmacy benefit managers (PBMs) pay for medicines, insurers typically use list prices - rather than discounted prices - to determine how much to charge patients with deductibles and coinsurance. Unlike care received at an in-network hospital or physician’s office, negotiated discounts for medicines are usually not shared with patients with deductibles or coinsurance.