— With many drug prices rising, consumers often pull
out coupons or discount cards from drugmakers to save
money when they buy medications at pharmacies.
some insurers are limiting how those discounts may be
applied amid concerns they’re driving up health care
costs for everyone. Curbing the coupons could mean more
money out of consumers’ pockets in the short term, but
in the long run could also help hold down drug prices
and health care costs, say critics of the cards and
Cross and Blue Shield of Illinois told its members with
individual plans this year they can still take advantage
of the discounts, but they won’t get credit toward
their deductibles or out-of-pocket maximums. Cigna only
allows coupons to be used for specialty drugs —
medications used to treat rare or complex conditions.
UnitedHealthcare and Aetna declined to comment on their
policies on the discounts.
number of experts and advocates for lower drug prices
applaud any actions aimed at stemming the use of copay
cards and coupons, which are available online, through
the mail or from doctors.
patients with individual and employer-based plans can
use the cards or coupons to save money on their
insurance copays for certain prescription medications at
the pharmacy. While a coupon can reduce all or part of a
patient’s copay, the insurance company still has to
pay its full portion for what might be a high-priced
drug — a cost that opponents of the discounts say is
ultimately passed on to all consumers in the form of
higher insurance premiums.
discounts made news last year amid outcry over the
skyrocketing costs of EpiPens, sold by Mylan. As part of
its response to the uproar, Mylan offered $300 savings
cards to patients with nongovernment insurance to help
lower their out-of-pocket costs. Mylan still faced
criticism that the discounts wouldn’t help everyone as
much as simply lowering the price would.
copay coupons are a scam by the drug companies,"
said David Mitchell, president and founder of Patients
for Affordable Drugs, a nonprofit that doesn’t take
money from drug companies or insurers. "Effectively
we wind up, all of us, paying a higher price for our
health insurance because they just steered us to a more
expensive drug that ultimately gets paid for by
benefit managers, which act as middlemen between
pharmacies and insurance companies, don’t like the
coupons either. The coupons are often used to drive
patients to higher-cost brand drugs instead of generics,
said Mark Merritt, president of the Pharmaceutical Care
companies, however, defend the practice as a way to make
sure patients have access to the medications they need.
The coupons "can provide a valuable source of
assistance for many commercially insured patients to
afford out-of-pocket costs associated with insurance
coverage for their medications," said Holly
Campbell, a spokeswoman for the Pharmaceutical Research
and Manufacturers of America, in an email.
like John Ellmann, of suburban Chicago, know how much
help such cards and coupons can be.
59, uses a copay card for a prescription migraine
medication he said would otherwise cost him $100
out-of-pocket for a month’s supply, with insurance.
"That would be a barrier to me filling my
prescription," he said.
copay card from the drugmaker takes his out-of-pocket
cost down to $10 a month, he said.
was among the Blue Cross and Blue Shield of Illinois
members with individual plans who were informed earlier
this year that the insurer would not apply the value of
the discounts toward deductibles or out-of-pocket
Miller, a spokeswoman for the company, said in an email
that Blue Cross put the policy in place in accordance
with federal rules and guidance as well as industry
concerns over use of the cards and coupons. "This
policy helps to ensure that the individual health
insurance market is more stable and affordable for all
of our members," Miller said.
in line with the federal government’s position on the
matter. The U.S. Department of Health and Human Services
said in the federal register in 2014 that it encourages
insurers offering individual plans to reject
cost-sharing payments from companies.
concern, especially in the individual market, is the
discounts could offset the balance of healthy versus
sick people who sign up for insurance plans by
attracting more sick people who might use the discounts
to those plans, said Harvard Business School Professor
Leemore Dafny. That could lead to higher insurance
premiums across those plans, she said.
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discounts cause other issues as well, she said. In a
recent study, Dafny and her co-authors found the prices
for drugs with coupons grew more quickly than prices for
drugs without coupons. They also found that coupons for
23 branded drugs, for which generics were available, led
to increased spending of $700 million to $2.7 billion
for those branded drugs over five years, according to
the study published in the American Economic Journal:
Economic Policy this year.
said she’s glad to see insurers taking steps to curb
the uses of copay coupons and cards, but she’d like to
see them and others go even further.
in some states already are taking action. California
lawmakers have been considering a bill that would
prohibit the use of coupons for drugs when other, less
expensive drugs are available. A New Jersey lawmaker
introduced a similar bill last year. Massachusetts
already bans coupons for branded drugs with generic
recipients also are prohibited from using the discounts.
acknowledged, however, that limitations on the use of
copay coupons and cards can be difficult for consumers
to swallow, even if they’re for the collective good.
coupons may save you money, but they’re keeping drug
prices high. Here’s how.
about time that the payer industry puts in place a
restriction to prevent the abuse of the insurance
coverage in this way, but there will certainly be
individuals who suffer some significant setbacks as a
result," Dafny said. "There aren’t free
the Highwood man with migraines, said he’s not upset
with Blue Cross’ new policy not to allow the value of
his copay card to count toward his deductible. It would
be nice, he said, but he understands the policy, given
that the $90 he’s saving through the discount isn’t
coming out of his pocket.
said he’ll still likely use the card, unless he’s
getting close to his deductible. He said he appreciates
the card because it allows him to "choose the
believes the controversy over drug copay coupons and
cards is just one small part of the ongoing battle
between insurers and drug companies when it comes to who’s
responsible for holding down health care costs.