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.