Why you should avoid the temptation of drug coupons

Why you should avoid the temptation of drug coupons

A version of this column was published on October 24th, 2012 in USA Today.

As the cost of prescription drugs soar, more patients are turning to online coupons or discount cards from drug companies or promotional offers in magazines. In the past year, it is estimated that 19 million Americans whom took prescription drugs used such incentives to save money. The healthcare industry has witnessed a five-fold increase since 2009, with 395 medications today offering a promotional savings program.

In most cases, drug coupons can expose patients to potentially higher long-term costs, increase health spending, and mainly exist to protect the profits of drug companies.

For example, let’s take a look at patients with high cholesterol. I normally prescribe the generic statin drug simvastatin, which has a monthly co-pay of about $10 in most commercial insurance plans. But I’m finding more patients specifically requesting Lipitor, Pfizer’s brand name statin, because of a web coupon which discounts co-pays to $4.

However, Lipitor costs over $1,400 more a year than simvastatin. So while patients pay less, their insurers are on the financial hook for substantially more. In fact, drug coupons are estimated to increase prescription drug spending by $32 billion over the next 10 years. Over time those costs come back to haunt patients.

“An individual patient who receives a coupon might not realize that, although that particular prescription may cost less that month, overall what it does is to raise costs for everyone, including themselves,” according to Susan Pisano, a spokeswoman for the industry trade group America’s Health Insurance Plans.

It is also important to consider that the terms of drug coupon programs are completely at the whim of drug manufacturers. Some limit how many times the coupons may be used. Others require patients to jump through hoops and regularly visit drug company websites in order to renew. Most patients are unaware of the potential privacy concerns, as they are usually required to divulge their personal information—sometimes including their home address and even part of their medical history—before receiving coupons or discount cards.

Worst of all, drug coupon programs can end abruptly. When this happens, patients whose chronic diseases are managed by expensive brand name drugs are left to financially fend for themselves. If they don’t proactively change their medication regimen to generic alternatives with their doctors, their annual drug costs can easily rise by several hundred dollars or more.  I’ve seen patients simply stop taking their drugs once their costs rise suddenly, which in the case of diabetes, hypertension or high cholesterol, can lead to severe, and more expensive medical complications.

As more brand name drugs go off exclusive patent protection, drugmakers’ revenue streams are under siege from the availability of cheaper generic equivalents. Just this past decade alone, drugs that brought in $110 billion in annual sales had their patents expire. In order to keep a slice of these evaporating dollars, the promotion of drug coupons will only become more aggressive.

Patients should collaborate with their doctors and do the math. Most conditions can be treated just as effectively with less expensive generic medications. Even with drug coupons, co-pays for brand name drugs generally exceed those of generics.

For a very small minority of patients, drug coupons may make sense. It may make sense in the few diseases where only brand name drugs are effective or in cases of extreme financial hardship where even generic medications are unaffordable.

The majority of patients should avoid the temptation of exploring drug coupons.

Why you should avoid the temptation of drug couponsKevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

Image credit: Shutterstock.com

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  • http://www.facebook.com/shelly.rosser.1 Shelly Rosser

    In addition, patients with Medicare Part D (which represents a large portion of those using these drugs) are not eligible to use these coupons because Part D is considered a government-funded program. Unfortunately, many drug reps do not mention this exclusion to the physicians and oftentimes, it is not until the pt gets to the pharmacy that they find out they cannot use the coupon. As a retail pharmacist, I see this all too often and sometimes it is difficult for the pt to understand why they are not eligible considering that the majority of Part D patients pay premiums and have copay’s.

  • Matthew Mintz

    I have to respectfully disagree. Your example of simvastatin is a perfect example. Lipitor (atorvastatin) is simply a better statin. If you need to lower your LDL by over 40%, you need at least atorvastatin 20mg or simvastatin 40mg. Simvastatin is associated with more side effects (even the FDA recently changed the label) and is one of the only statins to fail an outcomes study (A-Z trial). Simvastatin is not on the $5 Walmart or Target list. In fact, for most insurances simvastatin is at a second tier co-pay, so most patients will pay $20 or more per month. Before Lipitor went generic, is offered $4 a month coupon cards. What this meant for my patients is they could get a better statin for less than the price of a generic. Even though Lipitor is now generic as atorvastatin, Pfizer is still renewing the offer, so patients can still get it for just $4 a month.
    In many cases, the tried and true generics do just as well as branded medications. Lisinopril is a perfectly good 1st line blood pressure medicine. Metformin (per most guidelines) should be the drug all diabetics start on. However, especially in diabetes, patients usually need more than one drug. You could certainly go with a generic metformin/sulfonylurea combination, which will probably cost $10-$25 per month; however, this will cause dangerous hypoglycemia and weight gain. For the same price, with a coupon, you could use on of many branded combination products without the side effects.
    What is happening is that the industry is trying to circumvent the insurance companies disincentive not to use branded products- the higher co-pay. One can argue that the coupons just “increase the cost for all of us;” however, I have not seen data to support this. Pharmaceuticals are only 10% of health care costs and the vast majority of drugs prescribed are generic.
    As a physician, I must always keep cost to the system in mind, but I am first obligated to my patient (and not the insurance company). Generics still rule, but there is still a role for branded medications. Remember that most generic medications you use today were once branded products. When a generic medication is not enough or a branded product offers a significant benefit over a generic, I am going to prescribe a branded product. And I am also going to try to save my patient a few dollars by encouraging them to use coupons.

  • Easton Jackson

    Dr. Mintz, I think you’re incorrect on the Simvastatin. None of our major payers here (Utah) have Simvastatin as a tier 2. They’re all Tier 1. On top of that, Simvastatin is inexpensive. Costco lists their cash price as $11 for 100 Simvastatin tablets, even the 40 mg. That’s less that $40 for an entire year of therapy.

    It is true that a fair number of patient require more aggressive LDL lowering and may need to go to atorvastatin, but simvastatin is a very good and affordable choice for many.

    For what it’s worth, Costco now has generic Atorvastatin for $21 for 30 tablets, even the 40 mg. That’s a pretty reasonable price as well.

    Our clinic’s health insurance plan is self-funded. I despise these coupons. Our 3rd tier copay might be $45-50, and the coupon drops it to $20 for the patient. But the price we as a group pay for that drug might be $100-150. So, we’re still on the hook for the other $50-100. This bumps up our costs as a business.

    I think it’s critically important for patients to know the actual cost of their medications and their care, and it’s just as important for physicians to know the true cost as well. Yes, there are good reasons to prescribe some expensive medications. But we ought to be able to explain why we are writing for the more expensive med. There’s enough moral hazard in medicine. We don’t need to add more of it with these coupons.

  • http://www.facebook.com/vicki.ivancevic Vicki Ivancevic

    I use a discount coupon for one of my medications. There is simply no way that I could afford it otherwise. A generic is available but it is less effective and has a dangerous side effect. Since my insurance company has an outrageous co-pay for brand name medications, I don’t really have a choice. Would I like to be able to use the generic? Sure! I do that for almost all of my other medications. But this one gives me no choice….what other option would I have other than the discount coupon?

  • drjoekosterich

    As an Australian visiting the USA I was amazed to find coupons for drugs in magazines. Get your first week or two free! Even the inflight airline mag had one. This is about marketing not health

  • http://www.drwhalen.com/blog.html Santee Chiropractor

    Wow. People today are really stuck with marketing. They should focus more on how to make the medicines more affordable for the less fortunate. What do you suggest we do?

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