The new year has brought about a change if you use UnitedHealthcare’s Specialty Pharmacy network – a group of national and independent pharmacies – to get adalimumab (Humira). As of Jan. 1, pharmacies in the network stopped accepting manufacturer’s coupon cards for six drugs, including Humira, a biologic used to treat rheumatoid arthritis, psoriatic arthritis and juvenile arthritis; as well as certain drugs used for multiple sclerosis, organ transplants and hepatitis C.
The new coupon policy doesn’t change insurance coverage for these medications, so Humira will still be covered by UnitedHealthcare. But because the coupon cards covered most or all of the co-pay, patients will likely find themselves paying substantially more up front now.
However, patients can request reimbursement for the co-pay either online or by mail. The amount reimbursed depends on the insurance plan.
The new policy is intended to encourage members to consider lower-cost prescription alternatives. In an emailed statement to Arthritis Today, Daryl Richard, the vice president of public relations for UnitedHealthcare, says the use of coupons “can ultimately make medicines less affordable for all, as they incent the people we insure to select or continue using more expensive, higher-tier medications even when clinically similar medications on lower-cost tiers are available.”
Amy Melnick, vice president of advocacy for the Arthritis Foundation, says, “This is not only a large out-of-pocket increase in cost for patients who may already be stabilized on Humira, but it also sets a terrible precedent in the insurance industry by prohibiting co-pay assistance cards at the point of service.”
The Arthritis Foundation supports patients having access to all arthritis treatments approved by the U.S. Food and Drug Administration – and co-pay assistance can be a critical component to that access, Melnick says. The Foundation has written a letter with seven other organizations affected by this policy change to UnitedHealthcare expressing its concern about potential negative consequences.
Elizabeth Hoff, a spokesperson for Humira manufacturer AbbVie Inc., which split off from Abbott this month, says the majority of patients will pay no more than $5 out of pocket for each prescription if they are enrolled in the co-pay assistance program, and can get reimbursed in as few as five business days. Call 1-800-4HUMIRA (1-800-448-6472) for more information or submit for reimbursement online at my.debitrx.com.