Prescription Drug Copayment Coupon Landscape

    Additional Materials


    Patient Cost-Sharing for Prescription Drugs: Policy Issues
    Friday | February 16, 2017
    9:00 AM- 11:00 AM ET

    The Brookings Institution
    Faulk Auditorium
    1775 Massachusetts Avenue NW
    Washington, DC

    Health Affairs/ Evidence Base Blog Post:

    Prescription Drug Coupons: A One-Size-Fits-All Policy Approach Doesn’t Fit The Evidence

    A Perspective on Prescription Drug Copayment Coupons


    Prescription copayment coupons are distributed by pharmaceutical companies to reduce patients’ out-of-pocket copayments for specific drugs. When a commercially insured patient uses a coupon to fill a prescription, her copay is reduced and the manufacturer pays the balance of the copay. The patient’s insurer pays the remaining cost of the prescription. Copay coupons have come under scrutiny by some who argue they circumvent formularies and hinder generic substitution, thereby leading to higher drug spending. Others argue that coupons help patients access necessary drugs. To shed light on this issue, we examined copay coupon availability for the top 200 drugs (by spending) in 2014. Of these, 132 were brand drugs, and 90 of those had coupons available. No generic drugs had coupons. Among brands with copay coupons, 49 percent had a generic equivalent or close generic substitute available at lower cost. On the other hand, a majority (51%) were for drugs with no generic substitute—including 12 percent for drugs with no close therapeutic substitute of any kind. These results suggest that most copay coupons are not affecting generic substitution, and many may help patients afford therapies without good alternatives. As such, the copay coupon landscape seems more nuanced, and proposals to restrict coupons should ensure that patients who currently rely on them are not harmed.
    Download the full white paper here.

    Download the full technical appendix here.

    Karen Van Nuys, PhD
    Executive Director, value of life sciences innovation project, USC Schaeffer Center

    Geoffrey Joyce, PhD
    Director of Health Policy, USC Schaeffer Center

    Rocio Ribero, PhD
    Project Specialist, USC Schaeffer Center 

    Dana P. Goldman, PhD
    Leonard D. Schaeffer Director's Chair and Distinguished Professor of Public Policy, Pharmacy, and Economics, University of Southern California