TABLE 1.
Patient Case Cost Breakdown by Cost-Shifting Strategy
| Insurance type | Month | Manufacturer pays | Insurance pays | Patient pays a | Maximum out-of-pocket remaining ($8,000 max) |
|---|---|---|---|---|---|
| Traditional, no manufacturer assistance | January | $0 | $0 | $2,000 | $6,000 |
| February | $0 | $0 | $2,000 | $4,000 | |
| March | $0 | $1,200 | $800 | $3,200 | |
| April | $0 | $1,200 | $800 | $2,400 | |
| May | $0 | $1,200 | $800 | $1,600 | |
| June | $0 | $1,200 | $800 | $800 | |
| July | $0 | $1,200 | $800 | $0 | |
| August | $0 | $2,000 | $0 | $0 | |
| September | $0 | $2,000 | $0 | $0 | |
| October | $0 | $2,000 | $0 | $0 | |
| November | $0 | $2,000 | $0 | $0 | |
| December | $0 | $2,000 | $0 | $0 | |
| Total | $0 | $16,000 | $8,000 | — | |
| Traditional, with manufacturer assistance | January | $2,000 | $0 | $0 | $6,000 |
| February | $2,000 | $0 | $0 | $4,000 | |
| March | $800 | $1,200 | $0 | $3,200 | |
| April | $800 | $1,200 | $0 | $2,400 | |
| May | $800 | $1,200 | $0 | $1,600 | |
| June | $800 | $1,200 | $0 | $800 | |
| July | $800 | $1,200 | $0 | $0 | |
| August | $0 | $2,000 | $0 | $0 | |
| September | $0 | $2,000 | $0 | $0 | |
| October | $0 | $2,000 | $0 | $0 | |
| November | $0 | $2,000 | $0 | $0 | |
| December | $0 | $2,000 | $0 | $0 | |
| Total | $8,000 | $16,000 | $0 | — | |
| Copay accumulator program | January | $2,000 | $0 | $0 | $8,000 |
| February | $2,000 | $0 | $0 | $8,000 | |
| March | $2,000 | $0 | $0 | $8,000 | |
| April | $2,000 | $0 | $0 | $8,000 | |
| May | $0 | $0 | $2,000 | $6,000 | |
| June | $0 | $0 | $2,000 | $4,000 | |
| July | $0 | $1,200 | $800 | $3,200 | |
| August | $0 | $1,200 | $800 | $2,400 | |
| September | $0 | $1,200 | $800 | $1,600 | |
| October | $0 | $1,200 | $800 | $800 | |
| November | $0 | $1,200 | $800 | $0 | |
| December | $0 | $2,000 | $0 | $0 | |
| Total | $8,000 | $8,000 | $8,000 | — | |
| Copay maximizer program | January | $2,000 | $0 | $0 | $8,000 |
| February | $2,000 | $0 | $0 | $8,000 | |
| March | $2,000 | $0 | $0 | $8,000 | |
| April | $2,000 | $0 | $0 | $8,000 | |
| May | $0 | $2,000 | $0 | $8,000 | |
| June | $0 | $2,000 | $0 | $8,000 | |
| July | $0 | $2,000 | $0 | $8,000 | |
| August | $0 | $2,000 | $0 | $8,000 | |
| September | $0 | $2,000 | $0 | $8,000 | |
| October | $0 | $2,000 | $0 | $8,000 | |
| November | $0 | $2,000 | $0 | $8,000 | |
| December | $0 | $2,000 | $0 | $8,000 | |
| Total | $8,000 | $16,000 | $0 | — |
Alternative funding plans were not included in this table because cost variations being assumed by the manufacturer or patients are directed to a specialty pharmacy outside of the United States.
a Commercial insurance with an annual deductible of $4,000, a maximum annual out-of-pocket limit of $8,000. After his deductible is met, the patient is responsible for 40% of the drug’s price (plan pays 60%).