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Drugmakers offer these coupons as a form of marketing, and while they can help patients, before using them you should know a few things about how these programs work. This is the major attraction of drug coupons for patients. It's hard to see how saving money could be bad for your health. But health care decisions should be made between patient and doctor, without intrusion from marketing. Consider this: Doctors often have the choice of multiple drugs to treat any given ailment.
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Maybe Drug A, a tried and true generic, is the best choice for you, but you ask your doctor for Drug B because you have a coupon that would cover most of your copay. The doctor accommodates you, so you save money — but your treatment has suffered. This is not a hypothetical situation; a Consumer Reports analysis found more than one generic that works as well as or better than a name brand. Like a cable TV teaser rate, the coupon program won't last forever. Once you've established treatment for a chronic condition with the brand name drug, and the coupon ends, you may spend years paying the higher post-coupon price.
Some discount programs exclude members of Medicare, Medicaid, and uninsured people. Always read the fine print. Make sure to do the math before opting for a brand name with a coupon over a generic — the generic still might be cheaper. In addition to historic concerns that are similar to those regarding direct-to-consumer advertising 6 and the distribution of free medication samples 8 , there are particular provisions in payment policy that preclude the use of coupons for services covered by nearly all federal health care programs. For example, in , a group of trade union health plans sued eight large drug manufacturers claiming that drug coupon programs violate federal bribery laws.
However, in , the Massachusetts legislature created an exception to the law that allowed the use of coupons for branded drugs with no generic equivalent.
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This also lends added urgency to the issue of drug coupons. Our analyses had several limitations. First, we were unable to determine the dollar amount of the coupon used and therefore, the savings to the consumer, after accounting for coupons. Second, our analysis was limited to individuals filling prescriptions through retail pharmacies, since our data did not include individual-level claims data for transactions filled through mail-order services. Third, we assumed that the availability of a drug coupon only affects individuals who choose to use such a coupon, even though it is possible that the availability of a coupon affects the broader equilibrium prescription drug prices, formulary assignment, and out-of-pocket costs.
Fifth, these data capture only prescriptions paid for and given to an individual patient; therefore we were unable to account for prescriptions that were filled but never picked up. Sixth, we derived our analytic cohort from a larger cohort of opioid recipients, which may have diminished the generalizability of our findings. However, restricting our analyses to patients with no opioid fills after their incident statin fill had no substantive impact on our main results. Finally, our analyses do not allow determination of whether drug coupons result in lower utilization of generic medications.
Despite their increasing use, relatively little is known regarding the effect of drug coupons on consumer behavior.
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In the case of statins, we found that drug coupons are associated with greater utilization and lower rates of statin discontinuation and short-term switching. The funding sources had no role in the design and conduct of the study, analysis, or interpretation of the data and preparation or final approval of the manuscript prior to publication.
The authors gratefully acknowledge Christine Buttorff for comments on an earlier manuscript draft. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities.
National Center for Biotechnology Information , U. Author manuscript; available in PMC Jan 1. Kevin R. Caleb Alexander. Author information Copyright and License information Disclaimer. Correspondence: G. Copyright notice. The publisher's final edited version of this article is available at Pharmacotherapy.
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- Associated Data.
See other articles in PMC that cite the published article. Associated Data Supplementary Materials Appendix. Abstract Importance Drug coupons are widely used, but their effects are not well understood. Objective To quantify the effect of coupons on statin use and expenditures. Setting U. Participants Incident statin users who initiated branded atorvastatin or rosuvastatin between June and February Main Outcomes and Measures Monthly statin utilization [pill-days of therapy], switching [filling a different statin], termination [failure to refill statin for 6 months], and out-of-pocket and total costs.
Results Of 1. Conclusions Coupons for branded statins are associated with higher utilization and lower rates of discontinuation and short-term switching to other statin products. Setting and Participants We derived a closed cohort of incident statin users from a larger extract that contained all prescriptions from January through August for any patient who filled two or more prescriptions for an opioid in one of eleven states over any 1-year period during that time.
Measures We examined three measures of utilization and two measures of cost. Statistical Analysis We used generalized estimating equations GEE models, accounting for within-subject correlations over time to calculate the predicted and marginal effects of coupon use between coupon users in each group and their counterfactual non-coupon counterparts. Sensitivity Analyses We conducted several sensitivity analyses. Open in a separate window. Effect of coupons on statin utilization, switching and termination Table 2 depicts differences in utilization, switching, and termination between coupon users on atorvastatin or rosuvastatin and their counterfactual non-coupon counterparts within each group initial, subsequent, non-statin.
Table 2 Differences in average monthly atorvastatin and rosuvastatin utilization among coupon users and non-users. Effect of varying levels of coupon utilization Higher levels of coupon use resulted in higher utilization and a lower probability of switching and termination Table 3. Effect of coupon use on out-of-pocket and total costs All coupon users had consistently lower out-of-pocket costs than non-coupon users Table 4. Table 4 Differences in average monthly atorvastatin and rosuvastatin expenditures between coupon and non-coupon users. Sensitivity analyses Repeating our analyses stratified by atorvastatin and rosuvastatin Appendix Tables 1 and 2 with an open cohort of statin patients, patients with no use of mail-order prescription services and patients with limited opioid use Appendix Table 3 did not substantively impact the results from our main analyses.
Figure 1. Supplementary Material Appendix Click here to view. Acknowledgments Support and Acknowledgments Dr. Footnotes Disclosures Dr. References 1. Aiken M. Use and shifting costs of healthcare: A review of the use of medicines in the U. Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums. Health Aff. Grande D. The Cost of Drug Coupons.
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Donut hole This coverage gap with Medicare Part D means that after you and your drug plan have spent a certain dollar amount for prescription drugs, you have to pay all costs out of pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your prescription drug plan helps pay for covered drugs again.
Drug coupon Offered by drug manufacturers to consumers to reduce the price of their prescription drugs. Drug rebates Used by payers to reduce premiums and out-of-pocket expenses. Food and Drug Administration FDA The FDA is a federal government agency that is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of the nation's food supply, cosmetics, and products that emit radiation.
Generic drug Drugs that use the same active ingredients as brand-name medicines and work the same way. Generic drugs are the same as brand-name drugs in dosage, safety, strength, how it is taken, quality, and intended use. Mail order Mail order services allow individuals to receive prescriptions conveniently through the mail.
Medicare Advantage Plan A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Part D An optional program to help Medicare beneficiaries pay for prescription drugs. Over-the-counter drug A medicine that does not require a prescription. Preferred pharmacy network A group of pharmacies that give insurance plans a larger discount.
Premium A monthly payment you make to your health insurance carrier. Telehealth Encompasses a wide range of technologies to deliver virtual medical and healthcare services. Third party administrators TPAs Also called pharmacy benefit managers PBMs , they are paid to negotiate prices between pharmacies and large insurance companies. You have the right to safe, effective, and affordable medication. You can then print or download the coupons and vouchers to your smartphone and show them to your pharmacist to save money.
You have the right to pay less for prescription medications, using discounted coupons, rebates, and vouchers. Check one of the prescription pricing websites and apps to compare the cost of drugs and to find money-saving coupons on commonly prescribed drugs. You can even contact Congress by finding out who your U. You have the right to shop around. Call different pharmacies and ask for the lowest prices on prescription drugs. If you need to go to a different pharmacy to save money on one or more drugs, do so.
You have the right to ask your pharmacist for the very lowest prices on prescription drugs. Legislation signed into law in prohibits gag clauses. You have the right to go generic. Harris H. McIlwain, MD, a board-certified rheumatologist and geriatrician with two pain clinics in Florida, recommends that patients ask for generic drug equivalents, which are virtually the same as the pricey brand-name drug but much cheaper.
You have the right to contact drug manufacturers and ask about patient assistance programs PAPs. There are many programs offering free or discounted drugs to those in financial need or even to the general public. Do some homework and find out if your medications are provided free by the pharmaceutical company.
Start by locating the pharmaceutical company online. Do a search for the name of the company and the patient assistance programs offered. Fill out the online forms and have your doctor fax a letter of medical need.