Drug Coupons & Assistance Programs

Return to Policy & Issues

Drug companies rely on financial subsidy programs to increase product uptake among insured patients. Unlike means-tested patient assistance programs, which assist uninsured or indigent populations, copay assistance and free drug programs target patients who are already covered by insurance plans. By targeting drugs with sub-optimal formulary placement, these programs aim to rapidly increase product utilization outside the confines of traditional insurance processes.

Employer costs rise dramatically when enrollees choose expensive drugs over more affordable options. Drug coupons and copay assistance programs undermine employers’ ability to use utilization management tools, such as varying copay amounts for different-priced drugs, to reduce drug costs. Since the use of copay coupons reduces the utilization of more affordable medication options, overall prescription drug costs will continue to increase dramatically.

Considered illegal in federal health programs, copay coupons are banned in Medicare and Medicaid, but are still allowed in the commercial market (except in Massachusetts). Payers are supportive of programs that facilitate patient access to specialty and high-cost drugs. However, they do not support programs that undermine formulary design since additional expenditures do not provide patients with additional health benefits.

Research

Press Releases

PCMA Outlines 2015 Policy Agenda

  (Washington D.C.)—The Pharmaceutical Care Management Association (PCMA) today released its 2015 policy agenda, which includes reducing prescription drug costs...

Keep Reading