Drugmakers push back on a clever tactic employers use to avoid paying for specialty medicines
Health plan sponsors are excluding pricey specialty drugs from coverage, then tapping outside companies to help patients obtain the drugs for free from patient assistance programs.
In the face of rising drug prices, health plan sponsors have quietly used a clever, but questionable tactic over the past few years to deflect costs. And now, some pharmaceutical companies are pushing back.
The maneuver goes by different names — it’s sometimes called a specialty carve out, or alternative funding – but relies on exploiting charitable programs. It works like this: a health plan sponsor excludes certain expensive specialty medicines from coverage and taps an outside vendor to help patients obtain the drugs for free from patient assistance programs run by drugmakers or foundations.
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