• Jan. 1: UnitedHealthcare Plans to Make Physicians Track Patient Copay Coupons

    The Academy is working with patient and physician organizations that are concerned about a UnitedHealthcare (UHC) policy requiring physicians to maintain records and inform the insurer about copayment assistance patients get for drug treatments.

    Beginning Jan. 1, UHC plans to implement an accumulator adjustment medical benefit policy that would require providers to go through a 14-step process to submit information related to patients use of drug manufacturers’ copay coupons. The assistance would then be applied to a patient’s cost share (PDF) when billing for specialty medications as a medical benefit drug claim.

    UHC is shifting the burden to the provider to obtain coupon reimbursement information from the manufacturer and to submit that coupon value to UHC. The protocol notes that the reimbursement value entered may trigger a second review of a claim, which would lengthen the time to reimbursement and affect the patient’s responsibility for sharing the costs.

    The more time physicians and their staff have to spend completing administrative tasks, the less time they have for patient care. 

    Many specialty drug treatments are expensive, and without overall changes to drug prices, plan formulary design or patient cost-sharing, many patients have relied on copay coupons to afford their medications.

    Under UHC’s accumulator adjustment medical benefit protocol, if a patient uses a coupon to lower the cost of their drugs, physicians would have to report that assistance to UHC, and the insurer would not apply it to patients’ deductibles. The Academy is concerned that the policy means more out-of-pocket costs to our patients and jeopardizes our patients’ access to care.

    For ophthalmology patients, nonadherence to prescribed therapy could result in irreparable damage to the eye and even permanent blindness. This could potentially place ophthalmologists in conflict with the welfare of their patients, possibly violating the Academy’s code of ethics.

    Twelve patient and physician organizations have already urged UnitedHealthcare not to implement the policy. We’re also working with patient coalitions to get UHC to withdraw this plan and with the AMA on potential solutions.