The Patient Impact of Manufacturing Copay Assistance in an Era of Rising Out-of-Pocket Costs

This paper measures the impact of manufacturer-provided copay assistance on total out-of-pocket costs, drug utilization, and implications for patient outcomes. Using data dating back to 2015, we find manufacturer-provided copay assistance mitigated the rise in copay costs attributed to changes in commercial insurance designs as total commercial out-of-pocket cost exposure for prescription drugs would have risen over this period without copay assistance but fell over time with such assistance. We find that during this period, total out-of-pocket copay costs would have increased by 3.4 percent without copay assistance, but when copay assistance is taken into account, patient out-of-pocket cost exposure fell by 6.3 percent. Disruptions due to COVID-19 led to a decline in out-of-pocket copay spending across the board in 2020 but increasing copay assistance continued to improve affordability. Overall, this has resulted in a reduction of out-of-pocket spending by about 24 percent annually since 2015 due to copay assistance. Utilization and health outcomes would have likely been harmed without copay assistance as total out-of-pocket obligations trended higher. Instead, we find that copay assistance closed important affordability gaps, increasing utilization by 4.8 to 16.7 percent which in turn raised health outcomes by 1.0 to 3.3 percent. This evidence suggests that the affordability and access copay assistance provides has substantial benefit to the patients receiving them in today’s environment of rising overall out-of-pocket expenses.  Despite these benefits, recent policy proposals are making it more difficult for patients to access the full benefit of copay assistance. Drug manufacturers’ main role is discovering and developing drugs, but as the cost burden shifts onto patients, they temporarily expanded their role to help patient affordability until a better solution can be found.  In this paper, we discuss how our findings can be used to inform future policy discussions and proposals. Click here to read the full paper.