The researchers analyzed millions of pharmacy transactions by more than 600,000 people in the United States from 2017 to 2019 in order to get a better sense of how vouchers and other point-of-sale co-payment offsets are used.
Although the use of vouchers and coupons offered by pharmaceutical companies to defray patients’ out-of-pocket costs is concentrated among a small number of drugs, they are not targeted to patients with the greatest need for the price reduction, according to a study from Johns Hopkins Bloomberg School of Public Health.
The researchers analyzed millions of pharmacy transactions by more than 600,000 people in the United States from 2017 to 2019 in order to get a better sense of how vouchers and other point-of-sale co-payment offsets are used. These coupons and vouchers come in many forms, whether online directly to customers or through drug discount cards.
The study found that approximately half of the more than 4 million offsets included in the analysis were provided by pharmaceutical companies, and half were by pharmacies or pharmacy benefit managers (PBMs). In each of these categories, offsets were concentrated among a relatively small number of drugs. The research team found no evidence that offsets differed much depending on the local average income, ethnic or racial makeup, or level of insurance coverage.
The disease categories for which offsets for branded drugs were most common included diabetes, lung disease, and cardiovascular disease, and there was a clear concentration among a relatively small number of drugs. Further, 80% of manufacturer-sponsored offsets applied to 164 drugs, out of a total of 2661 drugs that received at least 1 manufacturer-sponsored offset. Similarly, 80% of pharmacy/PBM-sponsored offsets were for 156 out of a total of 3175 drugs receiving pharmacy/PBM offsets.
“The most significant finding was that these offsets are not being targeted to people who likely need them the most—for the pharmaceutical company-sponsored offsets, the goal may be mainly to maintain market share,” said study lead author, Aditi Sen, PhD, assistant professor in the Department of Health Policy and Management at the Bloomberg School, in a press release. “Understanding different offset types and which patients use them is important for designing policy.”
For this study, the team analyzed retail pharmacy transactions from the IQVIA Formulary Impact Analyzer during the period of October 2017 through September 2019. The analysis covered 631,249 individuals who had at least 1 use of an offset, and a total of 4,223,114 offsets. Of these offsets, 50.2% were from pharmaceutical manufacturers, 47.2% were from PBMs or pharmacies, and 2.6% were from state assistance programs, according to the study.
The analysis revealed that manufacturer-provided offsets tended to cover more of a drug’s costs, or approximately 87.1% of the out-of-pocket cost compared to 39.3% for the pharmacy/PBM offsets. More than 35.4% of manufacturer offsets fully covered the patient’s out-of-pocket costs, compared to just 0.8% for pharmacy/PBM offsets.
The analysis showed that offset use did not vary much between lower- and higher-income areas, even though lower-income patients are more likely to need and benefit from offsets. Further studies will be conducted to get a better sense of the factors influencing pharma manufacturers’ decision-making when they offer vouchers and coupons and to understand how offsets affect patients’ health outcomes, according to the study authors.
Drug coupons and vouchers cover only a sliver of prescription drugs. Johns Hopkins Bloomberg School of Public Health. Published March 29, 2021. Accessed March 31, 2021. https://www.jhsph.edu/news/news-releases/2021/drug-coupons-and-vouchers-cover-only-a-sliver-of-prescription-drugs.html