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Market Access

Copay Cards

What are copay cards for prescription drugs?

Copay cards are a form of assistance that pharmaceutical companies offer patients in order to reduce their burden of out-of-pocket costs including copays, coinsurance, and deductibles in the United States. The discount or terms of these cards can vary, but usually cover a significant portion of the out-of-pocket expense for a given drug. They are most commonly usable for patients with commercial (non-government) insurance.

Why can’t copay cards be used with Medicare Part D or Medicaid?

Federal anti-kickback statues do not allow for beneficiaries of Medicare and Medicaid to use copay cards to offset out-of-pocket costs. The rationale is that the out-of-pocket costs are a part of the risk evaluation and benefit design of the insurance program and are meant to skew the demand curve to limit moral hazard. and curb abuse.

A controversial program

There has been some controversy around copay cards and whether they negate aspects of insurance design which are meant to contain costs and ensure appropriate access. At the same time, high out-of-pocket costs, especially in high deductible or coinsurance plans has often made drugs inaccessible to those who need them.