Drug copay coupons may increase costs for members

While it may seem as though copay coupons help to contain rising prices, they can actually lead to increased drug costs.

Copay coupons promote brand-name drugs instead of generic drugs, regardless of whether they reduce the higher copay amounts often required for the higher-cost brands. In fact, copay coupons are available for more than 400 branded drugs, with the majority for chronic conditions. Less expensive alternatives are available for many of these. Coupons are usually available only for the first fill of the medication.

How coupons work: Crestor vs. generic Lipitor

What our Pharmacy Services leaders have to say

Laurie Wesolowicz, director, Clinical Pharmacy Services:

Copay coupons weaken employers’ ability to use different copay amounts to lower drug costs. For our records, we can't tell if the copay was paid by the member or through a coupon. So the member’s actual copay may count against their deductible and out-of-pocket expenses even though most of it was covered by the coupon.

Copay coupons do little to help the poor and uninsured. The coupons actually cause their costs to increase because manufacturers must raise drug prices to cover the costs they spend on coupons, making necessary prescription drugs more expensive for them.

To control copay coupon’s long-term effects on the health care system, health care providers must help patients make high-value health care decisions. Copay coupons should only be used when absolutely necessary by those with a true financial burden, and they should never be used when a cheaper, equally effective and clinically appropriate alternative is available.

James Lang, vice president, Pharmacy Services:

Coupon copay programs have become a big problem for health plans and employer groups. At the moment, drug companies have coupon programs for more than 400 branded drugs, mostly to treat chronic conditions. The coupons encourage you to choose the higher-cost brands, rather than more affordable, but equally effective, options. This leaves employers, including Blue Cross, footing the difference. If current trends continue, copay coupons will increase drug costs at least $32 billion by 2021.