CAAPs allow insurers not to count copay assistance toward our annual deductibles and out-of-pocket maximums. Patients still can use this assistance, but when it runs out, patients are on the hook for paying for their medications out of pocket. That means they will be hit with a major financial obligation mid-year after their copay assistance is exhausted.
For instance, my annual out of pocket maximum is $4,500. Before my employer instituted a CAAP, I could use copay assistance to help me reach this threshold, at which point my insurance, which I pay for through premiums, would kick in to cover subsequent costs.
Insurers argue that CAAPs incentivize patients like me to choose less expensive generic medications. But around 90% of drugs covered by copay assistance have no generic alternative.
For instance, I use a specialty biologic with no generic equivalent to treat my autoimmune disorders, including psoriasis and psoriatic arthritis. No other medication works. Without it, these conditions will once again ravage me.
The only less expensive substitute available to me is not taking my medication at all. According to the IQVIA Institute for Human Data Science, 69% of patients did not fill their prescriptions when they had to pay more than $250 out of pocket.
Roughly 10% of hospitalizations and 125,000 deaths each year are a result of nonadherence to prescription drugs. CAAPs will exacerbate this pandemic of medication avoidance.