In Catton's case the change meant that after she hit the drug manufacturer's payment cap for the copay assistance in April, she's had to pay the entire co-payment herself - roughly $3,800 - and will have to continue to pay it until her health plan's pharmacy deductible is met.įor May, Catton has put the $3,800 copay on a credit card. Under the copay accumulator programs introduced by some health plans in 2018, the process has changed. Through such programs, consumers typically have owed nothing or have had modest monthly copays for pricey drugs, thanks to a financial contribution by the drugmaker that chips away at the consumer's deductible and out-of-pocket maximum limits until the health plan starts paying the whole tab. Her health plan changed the way it handles Novartis' payments, and the money no longer counts toward that deductible.Ĭatton is one of a growing number of consumers taking expensive medicine who are discovering they are no longer insulated by copay assistance programs that used to help cover their costs. The drug's price: $90,000 each year.īut his year, Catton got a shock. Hospital nurse Kristen Catton relies on medication to keep her multiple sclerosis in check. Until recently those payments by the drug company helped Catton save money on her medical out-of-pocket expenses, because they counted toward her family's $8,800 annual pharmacy deductible on their health plan. Novartis, the company that makes Gilenya, helps defray that cost for Catton and other patients by making their copayments directly to the patient's health plan Catton's copay for the medicine is roughly $3,800 a month. The drug is expensive - about $90,000 a year. This is a big step forward two drugs she previously tried failed to control her physical symptoms or prevent repeated flare-ups.
Thanks to the medicine, she says, she's able to walk comfortably, see clearly and work part time as a nurse case manager at a hospital near her home in Columbus, Ohio. Since Kristen Catton started taking the drug Gilenya two years ago, she's had only one minor relapse of her multiple sclerosis, following a bout of the flu.
As the price of specialty drugs continues to rise, some health plans are shifting more of the cost to patients.
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