New “Fast Facts” Examines Issue of Co-Pay Coupons

August 2, 2017

Are coupons that help patients afford their co-pays a help – or a hindrance – in the age of innovative but costly prescription medications?  A new “Co-Pay Coupons” Fast Facts from the Institute for Patient Access explores why coupons and co-pay assistance programs remain a source of debate – and how they impact patients’ ability to access the medication their doctor prescribes.

About Co-Pay Coupons & Co-pay Assistance Programs

As health plans increasingly require patients to pay more out of pocket for their prescription drugs, some patients have come to rely on outside assistance. Co-pay coupons can reduce their out-of-pocket bill at the pharmacy counter, while co-pay assistance programs can provide funds to help foot the out-of-pocket bill for patients who meet income requirements.

Lower co-pays make medications more affordable – an important benefit, as studies show that high out-of-pocket expenses can discourage patients from taking medications as directed or cause them to abandon their prescriptions altogether.

But not everyone is eligible for these forms of assistance, the Fast Facts explains.  Medicare and Medicaid recipients cannot use co-pay coupons because of federal anti-kickback laws. Neither can patients with policies from some Affordable Care Act exchange insurers, who feel the anti-kickback rules could apply to their policyholders.

Costs & Access

Some critics have argued that co-pay coupon increase treatment costs by discouraging patients from selecting lower-priced alternatives or generic drugs. This has led Massachusetts to ban co-pay coupons and prompted a few other states to consider similar restrictions.

But, the paper asks, how do these restrictions impact patients?

Eliminating tools that make co-pays manageable may effectively block patients’ access to prescribed medications, leaving them to ration treatment or cut back on other essential expenditures like utilities or food. Such restrictions may also be one form of non-medical switching, where health plans drive stable patients to use a cheaper drug for reasons unrelated to their health.

Debate about the long-term cost impact of co-pay coupons is fair, the Fast Facts concludes.  But that debate should include how effective use of medication has the potential to reduce other health care costs, such as physician visits and hospital care – and how assistance can keep patient care a matter of health, not budget.

To learn more, read “Fast Facts: Co-pay Coupons.”

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