Relentless Health Value

Let’s cut to the chase here for our conversation about co-pay cards offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans. This whole war of the co-pays started back in the day when PBMs (pharmacy benefit managers) began to shake down Pharma for higher discounts. The prize that PBMs offered Pharma was lower co-pays for patients. It’s a well-known fact that the higher the patient out of pocket, the lower the market share of the drug—the old supply-and-demand curve at work. So, the PBMs and health plans kind of had an ace up their sleeve because they control how much the patient pays out of pocket. And so, they use that ace to pull in higher discounts from Pharma. “You’ll make it up in volume,” they told Pharma. “We’ll make sure you get lots of patients by putting your drug on a lower formulary tier and giving patients who take your drug the lowest possible co-pays.” At a certain point, pharma companies started to get mad about their dwindling net prices. And they