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Copay Coupons Allow Big Pharma to Keep Their Prices High


Published May 6, 2022 • by AHIP

Everyone should be able to get the medications they need at a cost they can afford. But drug prices are out of control, and hardworking families feel the consequences every day. Copay coupons are just one more Big Pharma scheme to price gouge patients, and health insurance providers recognize this “bait and switch” game. A recent opinion piece in the LA Times from Elisabeth Rosenthal, Editor-in-Chief of Kaiser Health News, detailed this copay scheme asking, “Is my copay coupon charity — or a bribe?”

Here is how Big Pharma employs these tactics: they incentivize patients to use very expensive drugs through a “copay coupon” rather than allowing patients and doctors to choose equally effective, less expensive alternatives (such as generics, biosimilars, and other therapeutic substitutes). This is why the federal government prohibits couponing in federal health care programs like Medicare and Medicaid as a violation of anti-kickback law.

They do this as an end-run around insurance providers, setting the terms and prices for the patients. Insurance plans do not receive the value of the coupon – in fact, insurance providers do not even know when these promotions are used unless a pharmacist reports them. Patients are completely in the dark on the actual cost of the treatment.

These promotions are offered only to very specific patients for a very short period of time. Once the patient hits their deductible, drugmakers stop providing their coupons. This scheme allows Big Pharma to keep their prices high, with patients, employees, and employers paying the cost.

Policymakers should ban these promotions and other third-party payments for brand-name drugs when a less expensive alternative is available to stop manipulating patients – and the market – for Big Pharma’s profit. Another solution would be to require drug makers to offer those coupons to all patients for the full year.

Or Big Pharma could simply lower the prices of their prescription drugs. But they won’t.

Health insurance providers will continue to fight for patients and consumers to make health care and prescription drugs more affordable.