Qualified medic examining senior man lungs with stethoscope

Copay Offers for Medicare Patients?

There is a new trend out there in copay – have you seen it? A few select companies and brands have begun offering real copay offers to Medicare patients in an effort to provide copay support to more of their patient base. These offers are not just the one-time “free trial” offers that we are used to seeing – these are full blown dollars off offers which give the discount for a longer period of time. How can this be done? You might ask…Isn’t that illegal?

Well…No, these offers are not illegal because the brands require the patient to “sign a waiver” and opt-out of their Medicare coverage for their brand. Once the patient has opted out of Medicare coverage then they are a cash paying patient. This is how it is being done, but the practice is not easy to execute and requires the patient to take a few extra steps to provide their consent. From a patient’s perspective, giving consent to opt-out of Medicare coverage must also be a scary thought.

Will the patients trust the brand enough to believe that the only thing they are opting out of is coverage for this particular brand and not out of Medicare completely? Clearly communicating this point will be a major focus for brands implementing this type of program.

We’ve seen this approach employed while a brand has still not secured their govt. contracting strategy and we’ve also seen it with established brands that have lost their exclusivity and have a large base of Medicare patients. While we have seen utilization rates not keeping up with traditional commercial copay programs, it still remains another option brands could consider.

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