"Non-Preferred" Generics Increase Co-Pays for Triptans, Other Drugs

Insurance companies are prohibited from denying insurance to chronically ill patients or charging them more for coverage under the Affordable Care Act. Instead, companies are raising costs for patients with health conditions that require expensive drugs (like migraine) by charging higher prices for generic drugs, according to an editorial published in the American Journal of Managed Care.1 The goal? Make plans as unattractive to sick patients as possible so they won’t enroll, according to ProPublica and The Upshot, a New York Times blog.2

You’re probably familiar with insurance companies’ “preferred” and “non-preferred” drug lists or tiered pricing. In both, certain drugs cost more than others, depending on the cost of the drug and whether or not it is generic. This has long been used to encourage patients to use generic rather than brand name drugs. Now companies are moving generic drugs to the “non-preferred” category, thus requiring patients to pay higher co-pays. For certain conditions, all generic drugs are “non-preferred.”

The price difference is usually $10 or $15, but it can be higher. Studies show that even a $1 price increase can prevent patients from taking their medications, according to A. Mark Fendrick, MD, a co-author of the AJMC editorial. When a patient takes multiple drugs in a month, these amounts add up quickly and could mean the patient is unable to afford the medication they need.

How this plays out for migraine will depend on the drug and the insurance company. The AJMC article looked at triptans, but other abortives and preventives could also be deemed “non-preferred.”

Patients already treat abortives as scarce resources, taking them only once they decide the attack is severe enough for one. For triptans, the most widely used migraine abortives, this actually provides less relief since triptans are most effective when taken when the pain is mild (not moderate or severe).3 Furthermore, the triptan most likely to remain on “preferred” lists is sumatriptan (Imitrex). Many patients do great with it, but others have terrible side effects from sumatriptan and not other triptans.

Preventives are even more problematic than abortives since so many patients have success with one preventive but not another. Drugs are not interchangeable for many migraineurs. Sure, we have the choice of multiple anticonvulsants or antidepressants for migraine prevention, but one drug in a class may be entirely ineffective while another works beautifully.

Our options for migraine treatment were already slim and constrained by cost and health insurance company requirements. Now it is even more difficult for patients to get the drugs they need.

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