Why Walmart, Home Depot are adopting this insurer tactic

Alyssa Rege - Print  | 

Walmart, Home Depot and other large U.S. employers are cracking down on drugmakers by offering their own programs to limit the amount patients spend on medication, Reuters reports.

Here are four things to know:

1. To have patients continue to use their medications, some drug manufacturers offer discount cards to keep patients' out-of-pocket spending low, and cover the rest of the payment required by the patient's employer. The industry's spending on copay cards has more than doubled to approximately $7 billion during the past five years, according data from consulting firm ZS Associates cited by Reuters.

2. Larger employers, like Walmart, claim the coupons drive up health plan costs and disincentivize patients — who use the discount cards for everything from multiple sclerosis treatment to arthritis medications — to seek less expensive treatment options.

3. Walmart, whose pharmacy is managed by Express Scripts, and Home Depot, managed by CVS Health, have begun offering programs that counteract the discount coupons offered by some drug manufacturers. These programs aim to either extract more money from drugmakers or redirect patients to cheaper medicine. A copay "accumulator" program recognizes when an employee uses a drugmaker discount card and ensures the money does not apply toward the patient's annual out-of-pocket spending requirement. When the copay card runs out, the patient must either cover the full copay cost, obtain a new discount card or stop filling the prescription. A copay "maximizer" program is more limited in scope, applying to a shorter list of drugs employees purchase from specialty pharmacies operated by Express Scripts and CVS.

4. Data from the National Business Group on Health suggests the programs are expected to expand within the next two years from about 25 percent of U.S. employers to as much as 50 percent, the report states. Executives from Pfizer and AstraZeneca told Reuters they are monitoring the effects the programs have on their businesses.

"The impact on our business is relatively limited, but it is a concern," an AstraZeneca executive told the publication.

To access the full report, click here.

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