Managed Healthcare Executive’s Senior Editor Peter Wehrwein featured John S. Linehan, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore and Washington, DC, offices, on the Tuning Into The C-Suite Podcast.
In this episode, Mr. Wehrwein and Mr. Linehan discuss the basics of drug pricing, coupons, and accumulators, who is advantaged and disadvantaged, and then dive into some of the details on CMS regulations and how recent proposed changes to Medicaid best price rules, if finalized, would affect coupons and accumulators.
Coupons and copay accumulators are a confusing, shifting battleground in this country’s struggle with high drug prices and costs—who pays how much, why, how, the pros and the cons.
Coupons shield patients from high out-of-pocket but can also undercut formularies. Plans and PBMs countered coupons with accumulators that keep a coupon’s value from being applied to the deductible.