As the House and Senate budgets head into conference committee negotiations, a new study reaffirms what we already know: prescription drug marketing coupons are a bad deal for health care consumers.
The study, The Cost of Drug Coupons, published in the Journal of the American Medical Association (JAMA), found that drug coupons can significantly increase both out-of-pocket costs and health care premiums for consumers. The study compared monthly and annual costs for three similar statin drugs: two brand-names which have co-pay coupons available and one generic. The brand-name version cost insurers five times as much as the generic, which in turn leads to higher health care premiums for everyone in the insurance pool. Even with the coupon discount, the co-pay for one brand-name drug was still more expensive than the co-pay for the generic, resulting in higher out-of-pocket spending by the consumer.
Drug coupon programs can also have detrimental effects on patient health and intrude into patient privacy. When a coupon program ends, patients unprepared for sharp increases in their prescription copayments may stop taking the medication and experience nonadherence-related side effects. Some drug coupon programs also require patients to give out their personal and medical information on websites, allowing pharmaceutical companies to target those patients in the future.
Urging physicians to avoid giving out drug coupons or encouraging drug coupon use unless the patient has demonstrated financial hardship and a clear clinical indication for that particular drug, the author warns – if pharmaceutical companies have the goal of reducing cost-related nonadherence, they should find a better way to reduce drugs costs for patients experiencing financial hardship.
Pharmacies have also begun to aggressively push back on drug coupon programs due to cost concerns, according to recent article in the Wall Street Journal. Drug coupons undermine the benefit designs meant to promote the use of lowest-cost clinically appropriate products, according to CVS Caremark, which has the second-largest pharmacy-benefit business. In an effort to counter the unnecessary use of expensive brand-name drugs promoted by coupons, CVS recently began blocking coverage entirely for 34 treatments – half of which were supported by co-pay coupons.
Repealing the drug coupon ban would raise out-of-pocket costs and insurance premiums for Massachusetts consumers and potentially cause pharmacy businesses to block coverage for certain medications at the expense of patient needs. At a time where our state is on the cusp of payment reform to contain health care costs, weakening our current drug coupon ban would be taking a step backward, rather than forward, in creating a more affordable health care system.