Copay Coupons, Get the Full Story

Copay Coupons, Get the Full Story

06.22.12 | By Greg Lopes

It's time to talk about the other side of the issue when it comes to copay coupons. This is a pretty simple issue from my perspective, it's about getting patients the medicines they need.

Unfortunately, one might think that drug copay coupons are going to be the straw that breaks the health care system's back. But when health plans and PBMs say they are concerned about the burden of rising costs, they are not referring to patients; they are talking about their business models.

"Copay coupons, which reduce or eliminate member copays for branded drugs, have flooded the market and are undermining benefit designs meant to promote the use of the lowest-cost, clinically appropriate products," CVS Caremark said in its recently published drug-trend report.

We think a patient's doctor, not their insurance company, is the best judge of what constitutes a clinically appropriate therapy. CVS' quoted statement is clear - it's about saving money by making patients purchase the cheapest drug, not the one the doctor decided would be most effective for his or her patient.

This is the side of the issue that explains how coupons allow patients to access medicines that otherwise might not be attainable. I've written many times about the danger of increasingly high copayments, especially when they restrict access to innovative treatments. Insurance companies often place innovative new medicines on specialty tiers, which typically require patient cost-sharing in the form of coinsurance rather than copayments. Coinsurance can be a real barrier to patient access to medicines and coupons can help break that barrier down.

The Amundsen Group has done some important research in this area. According to an analysis of copay coupon use in Pharmaceutical Executive, they found that specialty medicines account for the majority of copay coupon spending. They estimate that specialty products represent just over 51 percent of total annual spending on copay card programs and coupons. This is really important because it shows that coupons are being used where patients need the most help, where the cost sharing is prohibitively high.

They also found that, without copay coupons, up to one-third of patients with high cost sharing for specialty medicines would abandon their medicines. Why? The coinsurance makes the treatment too expensive.

Let's be clear: The point is that when patients cannot fill their prescriptions, they don't receive needed treatment for their disease, putting them at increased risk for poor clinical outcomes and potentially higher medical costs.

Copay coupons help ensure patients have access to the treatments they need; I think that's something we all should support.

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