![]() ![]() In deciding which drugs to include in its program, SaveOnSP targets drugs that have the most lucrative co-pay assistance programs, which include programs like CarePath, J&J claimed. J&J alleges that SaveOnSP intentionally circumvents the Affordable Care Act's patient protections by reclassifying critical medications as nonessential, regardless of the patient's actual needs as determined by their doctor. To facilitate this payment, payers sign "a 25% joinder agreement," which allows insurers to bill patients for that fee on a patient's administrative invoice. "What they call 'savings' is from patient assistance program funds," said J&J. In a statement shared with Healthcare Finance News, J&J said that SaveOnSP's model "inflates patients' copay costs in order to reduce what health plans have to pay to the pharmacy, and ultimately, health plans are able to extract patient assistance support away from programs like Janssen CarePath for the financial benefit of SaveOnSP and its partners."Īccording to a J&J spokesperson, SaveOnSP has extracted nearly $100 million in patient assistance support from Janssen CarePath alone and charges the payer "25% of the savings that's achieved." This results in the drug benefit plan reducing what it pays for each prescription. J&J's argument in the lawsuit is that SaveOnSP increases copays for some drugs and then bills J&J's copay assistance program, steering its payments to the drug benefit plan while taking a commission for itself. In response, many insurers have negotiated rebates, and they have shifted some of the costs to patients in the form of copays or coinsurance, which can add up to annual expenditures in the hundreds or thousands of dollars. Health insurers have been critical of copay assistance programs, saying they drive up costs while steering patients toward higher-priced brands. Out-of-pocket assistance through the program varies by drug but can be as much as $20,000 annually. ![]() J&J has its own copay assistance program, Janssen CarePath, geared toward patients with private or commercial insurance it covers patient copays and, in some instances, can reduce a patient's financial responsibility to about $5 per month, including for psoriasis drugs like Stolera, which has a list price of more than $12,000 per month. ![]() To help patients with commercial health insurance afford their copays, SaveOnSP helps employers and drug benefit plan sponsors save on pricey specialty drugs by enrolling them in copay assistance programs. SaveOnSP did not immediately respond to a request for comment.Īccording to The Wall Street Journal, the crux of the issue is the financial assistance patients can receive to mitigate their out-of-pocket prescription costs. The drug giant is seeking damages and is requesting that the court order SaveOnSP to halt its program. This, said J&J, is due to contract interference and deceptive trade practices by the company. In the civil lawsuit filed in federal court in New Jersey, J&J said it overpaid in copay assistance by at least $100 million due to the services provided by SaveOnSP. Drug manufacturer Johnson & Johnson has filed a lawsuit against drug benefit company SaveOnSP for allegedly taking advantage of a J&J program that covers out-of-pocket costs for patients who use some of the more expensive prescription drugs.īuffalo, New York-based SaveOnSP, which is run by PWGA Pension & Health Plans, describes itself on its website as "a service that negotiates prices for specialty drugs and, in exchange for the exclusive right to do so, guarantees that the recipients of those covered prescriptions will pay $0."
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