Easing the burden for your high deductible patients

Written by Al Kenney on 17 April 2017. Posted in Co-Pay Program Optimization


Easing the burden for your insured not covered “high deductible” patients is a problem for every drug today. You know almost 40% of Americans are on high deductible health plans and those plan’s drug copay deductibles are making it difficult for your patients to pay for their medications without assistance from you.

Any subsidy you provide will indeed help each patient get over their plan’s deductible “hump” as it counts towards their deductible. This is because the plan will only see the amount owed and will deduct that OOP from their deductible. You are essentially a secondary payer and any discount you offer will look like it came from the patient and reduce their OOP requirements for the year. Later in the year, as their deductible is met, they will have coverage on your drug and see lower OOP costs.

The hope is the patient gets to their deductible threshold as quickly as they can. Remember they might be taking other drugs whose offers will also be cutting into the patient’s deductibles which these days can average more than $2,000 per year per patient even within the same household (family deductibles are quickly becoming a thing of the past!)    

From a brand perspective it’s important to understand these patients who will show up as “insured not covered” (INC) patients when trying to process your offer. Many brands think of these patients as “cash paying patients” when they are not. While it’s true they will need to pay cash for your drug due to their deductible, this is only a temporary situation which should be rectified later in the year. So unlike true cash patients who will most likely disappear once your offer is expired, INC patients will still be there.

That’s important for your lifetime value calculations. For medications for chronic conditions, these patients will settle in and you should be able to recover much of the subsidy you laid out earlier in the year. Obviously this is not the case for acute drugs which is why they are more severely impacted by HDHP’s. You need to decide how to treat these INC patients when working on your program’s business rules.