October 9, 2013
Article Questions Long-Term Benefit of Prescription
New Haven, CT—Do the short-term savings provided by prescription drug “coupons” come at the cost of higher long-term expenses for patients and the overall healthcare system?
That is the question raised by a new Perspective article in the New England Journal of Medicine.
The article by Joseph S. Ross, MD, of the Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale–New Haven, CT, Hospital, and Aaron S. Kesselheim, MD, JD, MPH, of the Brigham and Women’s Hospital, and Harvard Medical School, both in Boston, also offers some interesting data about the pharmaceutical industry-provided perks.
Ross and Kesselheim write that, to conduct their analysis, they manually abstracted information on each coupon advertised in March 2013 at a large Internet drug-coupon repository.
Identifying 374 brand-name, prescription-only drugs for treating a variety of clinical conditions, they point out that 62% of coupons “were for brand-name medications for which lower-cost therapeutic alternatives were available”—whether a generic version or a therapeutic equivalent.
In addition, the authors note, more than 75% of the drugs they identified were for chronic conditions and would be expected to be used for 6 months or longer. The median monthly manufacturer subsidy was $60, with the amount ranging from $5 to $5,000, they add.
The Perspective article cites an IMS Health report stating that coupons were available for nearly 400 brand-name pharmaceutical products in 2011, with drug-coupon use increasing by more than 50% in the previous year alone. That report estimates that coupons were still used for less than 5% of brand-name prescriptions dispensed in the U.S., but other analysts have suggested that coupons were used for about 100 million dispensed prescriptions in 2010, or about 11% of brand-name drugs, according to the article.
Although the manufacturer coupons are designed to keep out-of-pocket costs for patients the same as if a generic drug had been purchased, the discounts usually have time limits, so patients eventually are hit with higher costs, Ross and Kesselheim point out.
“Once a coupon program ends, patients with chronic diseases face copayments for these brand-name medications that are higher than those for generic alternatives,” they write. “By that point, however, patients may have developed loyalty to the particular brand or may be skeptical about switching away from a medication that they perceive as effective—or they may not even be aware of alternative therapies.”
The authors argue that drug coupons “undermine the tiered-formulary system that commercial insurers have implemented to limit prescription-drug spending” and raise unresolved legal issues about whether they subvert the cost-sharing arrangements established in health insurance contracts.
“Everyone likes to save money, and coupons for essential therapies may be helpful for certain patients, particularly those with life-threatening conditions for which there are not reasonable generic substitutes,” the authors conclude. “However, the majority of drug coupons are for therapies for which lower-cost and potentially equally effective alternatives exist.”
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