Earlier this year, Johnson & Johnson Health Care Systems, Inc. – a subsidiary of Johnson & Johnson – filed a lawsuit against SaveOnSP, a drug benefit company, for allegedly taking advantage of a company program that covers out-of-pocket costs for patients who use some of the more expensive prescription drugs.
SaveOnSP helps employers and other benefit plan sponsors by enrolling patients in drugmakers’ patient assistance copay programs. The copay assistance programs subsidize the expense of certain prescription drugs.
J&J has a copay assistance program, Janssen CarePath, which helps qualify patients who have commercial or private insurance. Under Janssen CarePath, qualifying patients can have their copays covered for certain drugs, including the psoriasis drug Stelara. Stelara’s list price is more than $12,000 per month and out of pocket assistance for the drug can be as much as $20,000 per year.
According to the lawsuit, SaveOnSP works with drug benefit plan sponsors to enroll plan members in SaveOnSP’s program. Further, J&J alleges that SaveOnSP increases the plan’s copays for certain drugs, bills Janssen CarePath, and steers J&J’s payments to the drug benefit plan, taking a commission for itself. This process helps reduce the amount of money the drug benefit plan ultimately has to pay for each prescription.
J&J notes that the SaveOnSP program “at the heart of” the scheme starts by changing the designation of Janssen’s drugs from “essential health benefits” to non-essential health benefits under the Affordable Care Act, irrespective of the patients’ actual medical needs.
In the lawsuit, J&J alleges that SaveOnSP would sometimes raise a drug’s copay to the maximum benefit amount set by J&J, citing a SaveOnSP video presentation among other sources. In 2021, J&J said that it paid an average of $1,171 per prescription in copay assistance to Stelara patients who were not enrolled in the SaveOnSP program, compared to $4,301 for Stelara patients enrolled in SaveOnSP.
J&J goes on to note that once drugs are included in the SaveOnSP program, its copay is inflated to allow the payer to maximize the amount of copay assistance available, irrespective of how many times the patient fills the prescription. The lawsuit notes that similar to other maximizer programs, SaveOnSP blocks the funds from counting toward patient annual deductibles, which can result in patients paying higher deductible costs for other healthcare services and medications.
In the lawsuit, J&J alleges that it has paid at least $100 million more in copay assistance than it otherwise would have, as a result of the services provided by SaveOnSP. J&J states that this $100 million “deplet[ed] the support available for patients who cannot afford their rising copays” and that SaveOnSP knew that and “nonetheless has maliciously pursued this scheme to cause harm” to J&J and the patients it supports.
Johnson & Johnson also argues that the SaveOnSP patient assistance program prohibits patients from enrolling in any other assistance program, and that SaveOnSP interferes with this by strongarming patients to enroll in its own program.
J&J sent a statement to Healthcare Finance News, saying 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.”
J&J is seeking damages and injunctive relief that SaveOnSP’s program would no longer apply to Janssen drugs.