New Report Gives Health Plans More Reason to Fight Copay Coupons

By Lauren Flynn Kelly - September 4, 2013 A new report published by The New England Journal of Medicine may add more fuel to the copay coupon debate, as it suggests nearly two-thirds of copay coupons currently being offered by brand-name drug manufacturers are for drugs that have lower-cost therapeutic alternatives. Conducting their own analysis of the discount programs available, the article’s authors manually abstracted information on each coupon advertised in March 2013 at www.internetdrugcoupons.com and identified 374 brand-name, prescription-only drugs for a wide range of indications. More than 75% of the coupon-associated drugs were for chronic conditions for which therapies would normally be used for six months or longer. The authors determined that “62% of coupons (231 out of 374) were for brand-name medications for which lower-cost therapeutic alternatives were available,” while 58% of the drugs had a lower-cost generic alternative within the same drug class. Moreover, few of the coupons they looked at offered savings for more than a year. Once a coupon program ends, patients with chronic diseases who need to continue on these medications will be faced with serious sticker shock when they find out the actual cost of the brand-name meds they’ve become accustomed to taking. And if consumers download the coupons from the Internet and do not obtain them from their prescribers, then their physicians won’t know to help them by writing a script for a lower-cost alternative if available. As a result, it’s up to insurance companies or PBMs to reach out to members, but how do they know the coupons are being used? They often don’t, thanks to the “shadow claims system” described in the Pharmaceutical Care Management Association’s now famous Visante study. A report recently released by Crossix Solutions and covered in Drug Benefit News suggests that even though the actual number of copay card programs out there has decreased since 2012, their use among insured consumers has increased. However, data presented by Source Healthcare Analytics in February at the 2013 Pharmacy Benefit Management Institute Drug Benefit Conference suggest that payers need not worry too much. The data firm estimates that copay coupons targeted at brand-name drugs with generic equivalents accounted for only 16.3% of total claims associated with the cards in 2012. While there are two sides to this coin, and each side can find data to support its cause, we know that at least some coupon programs are problematic for payers. But instead of hearing further evidence of why they are problematic, I’d love to hear more from health plans and PBMs on what actions they are taking to prevent the use of troublesome coupons. What new or innovative strategies can you share to combat the ongoing problem of copay coupons? Feel free to comment here or email me at lkelly@aishealth.com. http://aishealth.com/blog/pharmacy-benefit-management/new-report-gives-health-plans-more-reason-fight-copay-coupons?utm_source=MagnetMail&utm_medium=email&utm_term=john@thebrokerageinc.com&utm_content=hbd090613&utm_campaign=Feature%3A%20Consultant-Turned-Whistleblower%20Drives%20$26%20Million%20Medical%20Necessity%20Settlement