From Cost to Care: Understanding the Impact of Copay Reduction Programs


In the ever-evolving landscape of healthcare, finding effective strategies to enhance patient outcomes is paramount. One such strategy, the reduction of copayments for medications, has garnered attention for its potential to significantly impact medication adherence. While not everyone in the industry agrees that copay programs are the answer to nonadherence, there is significant evidence to prove otherwise. 

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The Benefits of Copay Reduction on Medication Adherence 

Consider the following graph: 

Line graph showing relationship between high out of pocket costs and high medication abandonment rates. 

  1. Source: Medicine Spending and Affordability in the U.S. Published August 4, 2020.    
  2. Source: The Use of Medicines in the U.S. 2022: Usage and Spending Trends and Outlook to 2026. Minnesota House of Representatives; 2021. Accessed June 30, 2023.  

In 2020 and 2022, IQVIA’s Institute for Human Data Science presented findings about the relationship between prescription cost and adherence, clearly showing a strong correlation between increased cost and medication abandonment. 

Too many patients go without necessary drugs because of the financial strain it causes, and yet there is a clear solution to this issue. Copay reduction programs help to lower the out-of-pocket costs for patients, making medications more affordable.  This, in turn, leads to increased adherence to prescribed medications.  Studies have shown that patients with low copayments are more likely to take their medication as prescribed compared to those with high copayments. 

Manufacturers who provide competitive copay programs to patients in need begin a snowball effect that leads to better health outcomes for patients. These additional benefits include: 

  • Reduced avoidable healthcare costs 
  • Increased prescriptions of branded drugs written by prescribers 
  • Decreased health disparities among lower income households 

Nonadherence Hurts the Brand, too 

Outside of lower profits resulting from nonadherence, the health consequences resulting from misused medications hurt both the patient and the brand. For example, those with chronic conditions may opt to take their medications less frequently than prescribed, or in lower doses. This can result in adverse events such as unforeseen side effects, a decreased ability to manage symptoms effectively, or disease progression. 

Patients who report these issues may or may not be honest about if or how they are taking their medications, leaving prescribers with little choice but to lose faith in that drug and the manufacturer. These consequences highlight the importance of promoting medication adherence and implementing strategies, such as copay assistance programs, to reduce barriers to adherence. 

Who Argues Against Copay Assistance Programs and Why? 

Some payers and pharmacy benefit managers (PBM) argue against copay assistance programs. They believe that these programs are used to steer patients away from generic alternatives. ​However, it is important to note that this argument is not true for a significant proportion of copay assistance programs. ​

A study found that only 8.3% of branded drugs with copay coupons had generic equivalents. ​ Additionally, the use of copay cards on branded scripts with one or more generic equivalents represented only 0.4% of the total commercial market volume across all products. Therefore, while there may be some cases where copay assistance programs steer patients away from generics, it is not a widespread issue. ​ 

The Economic and Ethical Dimensions of Copay Assistance Programs

The evidence is clear: reducing copayments for medications not only supports patients in adhering to their treatment plans but also contributes to a healthier society at large. By examining the data and outcomes associated with copay reduction programs, we've seen how these initiatives can lead to improved medication adherence, reduced healthcare costs, and decreased health disparities among different socioeconomic groups.

Despite some opposition from payers and PBMs, the overall impact of these programs speaks volumes about their value. As we strive for a healthcare system that is both accessible and effective, embracing and expanding copay reduction programs could be a key step forward. As we continue to explore and implement evidence-based approaches to healthcare, the role of copay reduction in promoting better health outcomes cannot be overstated.

Understanding the Benefits of Copay Reduction

OOP expenses have emerged as the top barrier to quality healthcare access. Reducing drug costs with a copay savings program isn't just a financial relief to patients — it's a powerful catalyst for increased adherence and improved clinical outcomes.

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