Coupons From Manufacturers

I’ve talked about this a few times. It’s an interesting topic. Are coupons for prescriptions a good thing or a bad thing?

Let’s look at a few perspectives and considerations…

Manufacturer:

• Do they improve my marketshare?
• Do they protect my marketshare from new entrants?
• Do they protect my brand versus generic competition?
• Do they improve adherence (as measured by refill rates)?
• Per point of marketshare, is it cheaper to rebate a drug or offer direct-to-consumer coupons?
• Are coupons more effective than samples? (They are clearly less expensive to produce and distribute.)
• I’d be interested in feedback, but I haven’t found any conclusive data. BUT, I think manufacturers are smart marketers. They wouldn’t be doing this if it didn’t work.

Payor:

• Do the coupons support my formulary? (I would generally think no…otherwise why use them.)
• Do the coupons improve adherence? Are they creating waste?
• Are the coupons changing physician or patient behavior? Is this costing me money (e.g., less generic starts)?
• Is this impacting my total drug spend since the consumer is no longer as price sensitive to copay differentials?
• Do claims processing using the coupons still show up in the patient history such that drug-drug interactions and other safety checks can be conducted?

Customer:

• Am I saving money? [Yes]
• Is the coupon easy to use and understand? [I would think generally yes.]
• They should be asking about their total cost of the drug over time since depending on the condition they may be less likely to convert to a lower cost drug (typically generic) when the coupon is no longer offered. Or, switching drugs may require them to visit the physician or have lab work done that will cost them money.
• They should be asking…if others use this coupon, which means that they are filling a more expensive drug, what does that decision cost me (shared cost)?

As far as I know, there are very few limitations on couponing.

• The state of MA doesn’t allow their use at all.
• There are lots of restrictions about their use in Medicare and Medicaid such that those consumers are usually excluded from using the coupons.

This is generally a topic where there is little known about the answers to these questions (as far as I know).

There was an article in last week’s Drug Benefit News about this topic where I was quoted and built upon a few comments I made about Lipitor earlier:

“Payers are concerned that copay cards incent consumers to use higher-cost drugs,” George Van Antwerp, general manager of pharmacy solutions for Silverlink Communications, tells DBN. “The consumer no longer sees the penalty of using a more expensive drug.”

Pfizer, who declined to comment for this article, has given some indication that it will continue the $4 copay card only until November, when a generic version hits the market, but Van Antwerp says he’d be surprised if the company did not extend the offer. “Back when Zocor went generic, Merck actually made the brand drug cheaper than the generic drug,” Van Antwerp recalls. “United and a few other payers ended up putting brand name Zocor into the generic tier on their formulary.”