The Reality Regarding RxHelp™ Patient Choice Cards
There are a lot of myths circulating about these types of programs, what they offer, burden on the payor and privacy concerns. This document is intended to clarify the realities regarding RxHelp™ “Patient Choice” Programs.
Patient Choice Programs allow patients to remain on their brand name medicine with little or no cost over the generic equivalent. They have also been called brand loyalty programs, patient loyalty programs or manufacturers’ coupons.
|These programs increase public or private drug plan costs.||By following the patient’s drug plan and applying the proper coordination of benefits (COB) process [RxHelp™ Program Cards are either 1st or 2nd payor], the public or private payor will pay no more than they are willing to pay for the dispensing of the brand name product instead of the generic.
In the case of any particular COB claim the patient’s drug plan(s) may in fact see reduced costs due to being moved down the list in the hierarchy of payors.
|If the patient’s drug plan pays for brand name drug, even when a generic equivalent is available, these programs increase the cost to the payor.||The decision to continue therapy on a brand name drug is a process involving the patient and their health care providers, however, the ultimate decision resides with the patient; the mission of RxHelp™ Patient Choice programs is to remove any financial consideration or barrier from this very important health care decision.
If a payor does not wish to pay the brand price, a simple plan design change that allows only generic price level reimbursement, which is becoming the predominate form of drug coverage in Canada, would address any drug cost concerns.
|Since these card programs are setup as “Payor of Last Resort”, they are attempting to push the costs to all other payors before the brand company pays for any portion.||RxHelp™ Program Cards are all set up as either 1st or 2nd payor and are never set up as the payor of last resort.
If the patient has a reimbursement style plan or no other coverage the RxHelp card will pay first. If the patient has other public or private coverage it acts as the second payor.
|Pharmacies that are part of national/provincial chains do not accept these card programs.||Our experience has been that many individual pharmacies within national/provincial chains that value patient choice have and continue to accept RxHelp™ card programs. If your particular pharmacy does not accept the card there may be another one in your area that does.|
|Patient Choice Programs are against the regulations in Quebec and are not accepted.||The Quebec Ministry of Health has expressed concerns in particular with programs that apply to drugs that have not been on their plan greater than 15 years. However, there are no specific regulations that indicate that Patient Choice Programs are not allowed. In fact, there are currently RxHelp™ Patient Choice Programs available in Quebec and accepted by pharmacies.|