Many doctors are worried after learning that a health insurer is offering some customers a financial incentive to stop taking a certain arthritis medicine.
Cigna is offering eligible patients a $500 prepaid debit card to stop taking Cosentyx and switch to something else.
Action 9′s Jason Stoogenke found many doctors are concerned their patients may choose the quick cash over their health.
The American College of Rheumatology criticized the program stating that, “financially incentivizing patients to switch medicines is wrong.”
The organization developed a resolution, which even mentions Cigna by name, that the American Medical Association passed. Read it here.
The AMA states that it is against “the practice of insurance companies providing financial incentives for patients to switch treatments” and that it would even support “legislation that would ban” the practice.
The program also rubs many local rheumatologists the wrong way. One called it an “outrageous act by Cigna,” while another told Stoogenke “it doesn’t seem very ethical of Cigna.”
Some patients, such as June Suttles, said they’ve tried other drugs but that Cosentyx works the best for them. She has psoriatic arthritis which causes her joints to hurt, especially her legs.
“I’ve used several different medications, from pills to topicals to shots …none of them really worked really well,” she told Stoogenke.
“About four years ago, my arthritis doctor told me he wanted me to try a new drug called Cosentyx. It was actually like a miracle drug; within a month, I could see huge, huge results,” Suttles said.
She told Stoogenke Cigna didn’t offer her one of the $500 debit cards, but she would have said no. “Because I know how effective this medication is and it would be upsetting,” she said.
“I don’t think they are doing things that other companies are not, but they seem to be more aggressive in using this tactic of getting patients to switch,” said Lisa Rasmussen, a medical ethics professor at UNC Charlotte.
She says the real issue may be with our health care system in general. “I think we should always work on trying to save money for patients, for the health care system, for the taxpayers. The question is what we lose when we go out for that too aggressively.”
Stoogenke contacted Cigna, which stated:
“We are committed to driving medication affordability for customers and clients, and this pilot program is designed to help achieve that goal. Over the past several years, brand-name treatments for inflammatory conditions have been among the highest drivers of drug spending. In addition to regularly reviewing our formularies, we introduced a limited pilot program intended to encourage eligible Cigna customers to talk to their doctors about appropriate alternatives – ones with similar clinical efficacy, yet at a much lower cost. In all cases, the prescribing physician and patient makes the final decision.”
Cigna adds medication to incentive program
First, Cigna offered some patients $500 not to take Cosentyx. Now, the health insurer wants some patients off Remicade too, which is used to treat Crohn’s disease and certain types of arthritis, among other things.
Cigna has acknowledged Remicade can be “life-saving and life-changing,” but says it can also be “financially devastating” for patients. It says the average regimen costs $30,000 per year but can go as high as $75,000 annually.
So, the company is offering some customers a $500 prepaid debit card to switch to less expensive medications Avsola or Inflectra.
Remicade is considered a biologic while Avsola and Inflectra are what are called biosimilars. As the name suggests, the FDA says biosimilars are “highly similar” to biologics and have “no clinically meaningful differences” to them.
Still, some doctors feel Cigna’s debit card incentive puts undue pressure on patients.
“It’s unfortunate in the pandemic when patients may be under financial duress for an insurance company to say, ‘Hey, we’ll give you $500 if you go ahead and make a change,’” rheumatologist Dr. Andrew Laster told Stoogenke.
“The insurance companies do not know the patient like the doctor does in terms of the drugs that they’ve been on before, possible side effects, the underlying disease,” Laster added.
Janssen, the company that makes Remicade, told Stoogenke: “We believe that medical treatment decisions belong in the hands of the patient and their doctors who best understand the patient history, current condition and treatment needs. We are concerned about any program that encourages clinically stable patients to switch therapies for non-medical reasons unless the therapies are deemed substitutable by the FDA. We want to safeguard the doctor-patient partnership and treatment choice.
“We are committed to the access and affordability of our medicines and to helping patients in their treatment journey. Our longstanding Janssen CarePath program can help patients find the resources they may need to get started and stay on track. For more information, visit JanssenCarePath.com/Patient/Remicade or call 877-CarePath (877-227-3728).”
Stoogenke found a section on Remicade’s website called “Being asked to switch.” Janssen stated that it posted the information before Cigna started its program, not in response to it, but it warns patients they may get a letter asking them to change meds. It offers this multi-page “discussion guide” for patients and their doctors here.
But Cigna defends its program and says it’s “taking concrete steps to help patients and plans realize the promise of alternative, clinically effective treatment options.”
It also states, “At a time when many people are having to make difficult decisions related to how to afford their medications, this program will offer some direct financial relief and position customers and their employers to recognize greater long-term cost savings.”
Stoogenke contacted other insurers to ask if they offered debit cards to patients to stop taking Cosentyx, Remicade or other medications.
Blue Cross Blue Shield said it did not.
Medicare said it doesn’t either but that it sometimes offers people up to $600 for making healthy lifestyle choices and taking their medicines like they’re supposed to.
A few other insurers did not respond in time for this report.
Stoogenke encourages patients to be honest with your doctor so they can treat you properly.
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