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Study questions drug-discount programs


NEW YORK — Over the last few years, many drug makers have offered coupons and co-payment-assistance programs as a way to reduce patients' out-of-pocket spending on medications, but a new study questions whether they really reduce spending in the long run and whether they're even legal.

The study, conducted by Yale University medical professor Joseph Ross and Harvard University public health professor Aaron Kesselheim and published in the New England Journal of Medicine, analyzed coupons for 374 branded drugs for a variety of conditions listed on For 8% of the drugs, a cheaper drug that was therapeutically equivalent was available, but for 58% of the other products, there was a generic alternative in the same therapeutic class; in total, 62% of coupons were for branded drugs for which lower-cost alternatives were available.

"The widespread availability of coupons for brand-name pharmaceuticals that can be expected to be used long term and for which lower-cost alternatives are available has important implications for patients," the authors wrote. "Despite the short-term savings achievable with coupons, they do not offset higher long-term costs, because they're nearly always time-delimited."

Ross and Kesselheim noted that some coupons can be used once, and others more than once, but few could be used for more than a year, and once a program ended, patients would have to pay normal copayments. But by that time, they may have acquired a brand loyalty, and physicians may be slow to switch them to alternatives. In addition, while coupons may reduce out-of-pocket costs for drugs, insurers still had to pay the higher cost.

The authors also cited pending lawsuits against drug manufacturers, alleging that coupons subvert cost-sharing arrangements in patients' contracts with insurance companies and should be banned as illegal kickbacks.


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