Could Copay Assistance Narrow Health Inequities?

Many people are unable to afford healthcare and medication, which often results in individuals not filling or picking up their prescriptions. Around 25% of U.S. adults report that they or someone in their household have cut pills in half, skipped doses of medication, or have not filled a prescription due to cost concerns. These reports are more common among Black and Hispanic people and adults with lower incomes.

Copay assistance programs from pharmaceutical manufacturers, such as free trial vouchers or copay discount cards, lower patients' out-of-pocket costs for branded prescription drugs. They are controversial, though, because some payers say drugmakers use the assistance programs to create demand for their high-priced products. Regardless, patients may not know about them, and the connection between copay assistance utilization and “prescription abandonment” — not picking up prescribed medication — hasn’t been clearly identified across different demographic groups.

A recent study has found a link between the use of copay assistance among commercially insured patients prescribed certain rheumatoid arthritis (RA) or oral anticancer drugs, and lower rates of prescription abandonment, regardless of race, ethnicity, or income level. The Genentech-funded study was published in the Journal of Managed Care & Specialty Pharmacy.

The researchers analyzed drug claim data from a consumer database and included the first prescription for certain branded RA or cancer drugs filled from 2016 to 2020. The sample included 67,674 patients prescribed RA medications and 9,560 prescribed oral anticancer drugs.

Their analysis revealed that Black/African American and Hispanic patients prescribed RA medicine and patients with incomes lower than $50,000 were more likely to abandon their prescriptions. In patients prescribed RA medicines, Black/African American, Hispanic, and lower income patients were more likely to abandon their prescriptions and less likely to use copay assistance compared with White and higher income patients, respectively.

For patients receiving oral anticancer drugs, a disparity in prescription abandonment was observed between the highest and lower household income levels, but no racial or ethnic differences were seen.

Copay assistance was associated with a 79% lower odds of prescription abandonment among people with rheumatoid arthritis and a 71% lower odds of prescription abandonment among those prescribed an oral cancer drug. The lowering of the odds did not differ by race, ethnicity, or income level.

“The observed racial/ethnic and income disparities in patients abandoning their prescriptions highlight some of the challenges these patient groups face in accessing their medicines,” said lead study author William Wong, Pharm.D., M.S., of Genentech. “This is particularly concerning given these patients are being prescribed medicines for chronic and serious conditions for which drug therapy is an important part of the management of these diseases.”

Further, Wong explained: “The results suggest a potential health equity impact of copay assistance which should be considered by policymakers and other stakeholders when discussing opportunities to improve current disparities in access to medicines as well as debating the role of copay assistance in the healthcare system.”