Copay help eases patient costs but may blunt price pressure, critics say

Manufacturer-linked copay assistance for expensive drugs such as those used in ATTR-CM is facing renewed scrutiny over its effect on prices.

Federal law bars drugmakers from directly covering copays for Medicare patients. In 2018 Pfizer paid $23.85 million to resolve allegations that it used a foundation as a conduit to pay Medicare copays for patients on three of its drugs. Prosecutors said Congress included copays in Medicare partly so market forces could check drug prices. Pfizer did not admit liability.

KFF Health News reported that critics see such programs as shielding patients from price increases while taxpayers cover the rest.

ATTR-CM drugs cost more than $240,000 a year at list price, according to ICER and published reports, and treatment can last years.

Policy researchers say assistance run by independent charities, available across all appropriate drugs, avoids the conflict. The HHS Office of Inspector General sets out the anti-kickback rules that govern such arrangements.