Pharma charities and drug co-payments

2019-09-03

in Economics, Law, Politics

I hadn’t heard about this weird distortion in the US medical system, where pharmaceutical companies use tax-exempt charities to manipulate the co-payment system used by health insurers for prescription drugs:

Half of America’s 20 largest charities are affiliated with pharmaceutical companies.

Pharmaceutical companies will often claim that helping patients with their co-payments is a way of making costly drugs more accessible. But it has the fortunate consequence of making their customers price-insensitive, because insurance companies will often use high co-payments to nudge their customers into opting for generics over costlier branded drugs: no co-pay, no incentive to save money.

The Securities and Exchange Commission (sec) is also looking more closely at independent charities that are sometimes sponsored by pharmaceutical firms. One independent charity offered co-pay support only for a specific type of “breakthrough pain” for cancer patients, a condition its sponsor had a 40% market share in treating. An sec probe has already settled claims with some pharmaceutical firms, though none has admitted wrongdoing. United Therapeutics has settled the biggest claim, worth $210m, with the Department of Justice. Lundbeck, a Danish drugmaker, and Pfizer have settled smaller claims. “Pfizer knew that the third-party foundation was using Pfizer’s money to cover the co-pays of patients taking Pfizer drugs,” according to Andrew Lelling, a us attorney, “masking the effect of Pfizer’s price increases.” Johnson & Johnson, Astellas, Gilead Sciences, Celgene, Biogen and others face investigations.

America’s health system is convoluted to the point of being surreal, as well as manipulated by the huge influence of the pharmaceutical industry on legislators.

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