Copay maximizers are a health plan strategy that harms people with bleeding disorders and other serious health conditions. Health plans and affiliated PBMs use copay maximizers to redirect and drain copay assistance funds. In so doing, health plans profit from copay assistance programs that were supposed to help patients – while creating complexity and confusion, and exposing patients to higher overall health spending.
Background STIMATE® has been unavailable to patients since July 2020, when Ferring Pharmaceuticals and CSL Behring announced a voluntary recall of the product. Patient concerns continued when, in February 2021, Ferring Pharmaceuticals stated that it did not anticipate restarting manufacturing and market delivery of STIMATE® before the second half of 2023, contingent on FDA approval. […]
Many in the bleeding disorders community rely on patient copay assistance programs to help defray the out-of-pocket (OOP) cost of their prescription drugs. Unfortunately, health insurers increasingly are refusing to credit copay assistance toward patients’ deductibles and OOP maximums.
Medicare provides essential coverage for seniors as well as some younger people with disabilities.
Medicaid provides essential access to treatment and care for many people with bleeding disorders.
“Fail first” requirements are inappropriate in bleeding disorders care and can harm patient health. Lawmakers should establish clear timelines and processes for obtaining exceptions to step therapy protocols.
Patients with chronic disorders need the same medicine for long periods of time, often a lifetime. Requiring their medication to be pre-approved multiple times a year, through a lengthy and arcane process, creates unnecessary burdens for doctors and causes unnecessary delays for patients.
Hormonal or hormone-based therapies are commonly prescribed as first-line therapy for menstruating people with bleeding disorders. HFA will robustly defend continued access to these and all other safe and effective therapies and services that people with bleeding disorders need.
Mindful always of our community’s history, HFA has pledged to remain vigilant and engaged in matters of blood and product safety.