Second pass at: Manufacturer assistance programmes and their eligibility rules — setting out what I have, and where I think it stops being reliable.
Two things I would like separated before anyone answers on Manufacturer assistance programmes, because they get bundled and then argued about as one thing.
The first is descriptive: what has actually been observed, by whom, and how. The second is causal: why. I am asking about the first only.
The arithmetic on Manufacturer assistance programmes is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.
Discount programmes and coupons: manufacturers often offer coupons that reduce out-of-pocket costs if insurance is not covering or is covering at a high copay. These have eligibility restrictions but can save money.
It is worth checking rather than assuming, which costs nothing.
The arithmetic in post #3 is right; the assumption feeding it is the part to check.
Worth stating the null on Manufacturer assistance programmes before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
A note on how Manufacturer assistance programmes gets discussed rather than on Manufacturer assistance programmes itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
Everything in post #3 holds. The case it does not cover is the one I have.
Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live.
Posting it because the silence on this was starting to look like agreement.
Narrowing post #7, because the general version has more than one answer.
The most useful pricing posts here are the ones that show the arithmetic rather than the conclusion.
Checked the Manufacturer assistance programmes claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.
This follows post #7 rather than contradicting it.
Discount programmes and coupons: manufacturers often offer coupons that reduce out-of-pocket costs if insurance is not covering or is covering at a high copay. These have eligibility restrictions but can save money.
Happy to expand any of that if it is the useful part.
Two claims get bundled together under Manufacturer assistance programmes and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
Post #12 is right about the mechanism and I think understates the practical bit.
Insurance tier placement: a compound might be covered but on a higher tier (higher copay). Moving to a lower tier usually requires prior authorization or documented failure of cheaper alternatives.
Coming back to post #10, because the follow-up matters more than the original answer.
On Manufacturer assistance programmes, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the interesting bit.
If you can post the two or three numbers you are working from, several people here will check the arithmetic rather than argue about the conclusion.
Discount programmes and coupons: manufacturers often offer coupons that reduce out-of-pocket costs if insurance is not covering or is covering at a high copay. These have eligibility restrictions but can save money.
I am describing what is, rather than arguing for what should be.
What would change my mind on Manufacturer assistance programmes is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.
I had written a reply contradicting post #14 and deleted it. Here is what survived.
The useful distinction on Manufacturer assistance programmes is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.
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