The Cost of Drug Coupons

Abstract

MANY PATIENTS CONTINUE TO STRUGGLE WITH THE costs of pharmaceutical products. For patients with chronic diseases, pharmaceutical costs are an unremitting expense. Nonadherence related to the cost of pharmaceutical agents is a major public health issue. This nonadherence is associated with increased hospitalizations and adverse health effects such as increased risk for stroke and acute myocardial infarction. Although Medicare Part D has decreased cost barriers to obtaining medications, 20% of Medicare beneficiaries in fair or poor health report cost-related nonadherence. Enhanced adherence is an important strategy to improve health outcomes. Drug coupons that discount patient co-pays have emerged as a popular tool to decrease the financial burden of prescription drugs. From 2009 to 2011, the number of drug manufacturer coupons increased markedly, to an estimated 340 individual drug coupon programs. Drug coupons are an attractive option for physicians and patients. Coupons can substantially reduce patient cost sharing by directly discounting co-pays. For physicians, coupons can be an effective way to help patients afford costly medications and manage chronic diseases. Coupons also represent a safer alternative to free drug samples because they shift dispensing back to licensed pharmacists. For patients, coupons are a familiar way to obtain discounts, and extending this model to pharmaceutical products seems logical. But could these coupons carry a cost that physicians and patients are overlooking? Drug coupons raise 2 primary financial concerns. First, coupons can increase out-ofpocket spending for the coupon user in either the short or long term because co-pays may still be higher compared with therapeutic alternatives (ie, direct costs). Second, coupons can increase health care spending for coupon users and nonusers by increasing aggregate health spending and thus health insurance premiums (ie, indirect costs).