Copay coupons have long been a contentious topic in pharma, as critics have blasted the promo strategy for driving up drug costs. Now, a study has found that the coupons helped slightly with medication adherence—and moved doctors to prescribe costlier, more effective options—but didn't improve health outcomes for patients who'd suffered a heart attack.
In a study of P2Y12 inhibitors—a class that includes AstraZeneca’s Brilinta and Eli Lilly’s Effient—researchers divided 301 hospitals into groups of doctors who provided copay coupons for their patients and those who didn’t. The study looked at more than 11,000 patients who’d suffered a heart attack and found that the group who received coupons had a 3.3% increase in medication persistence after 1 year versus their counterparts, while they had no benefit in health outcomes.
At the same time, the coupons also seemed to make doctors more comfortable prescribing guideline-preferred options that carry higher costs, according to the study, which was published in the Journal of the American Medical Association.
Doctors in the copay coupon group were more likely to prescribe guideline-recommended options in ticagrelor and prasugrel—generic names for Brilinta and Effient—over clopidogrel, the generic name for Bristol-Myers Squibb’s Plavix. The study didn't include copay coupons for Effient, but doctors in both groups were free to prescribe the drug.
Plavix had gone generic at the time of the study, while Brilinta and Effient were both branded "and often were associated with higher out-of-pocket costs," according to the authors.
The investigators noted another important finding. They pointed out that only 72% of patients who’d been given a copay coupon actually used it, “likely attenuating the potential clinical effect of the intervention," authors wrote in an accompanying JAMA editorial. Further, patients who didn’t use their coupons were more likely to have a lower income or not have insurance, “suggesting that perhaps patients who could have benefitted the most from the voucher were the ones who did not use it," the editorial authors wrote.
Copay coupons have been a divisive tool in the pharma world. Drugmakers say they help patients afford their drugs, while payers and critics say they drive up overall costs by encouraging use of costlier options.
Payers have come out against the promo strategy in years past. Express Scripts, CVS Health and UnitedHealthcare each have introduced programs to target dozens of drugs that heavily relied on the coupons. In a previous blog post, Express Scripts said copay coupons “inject waste” into the healthcare system. The PBM giant, now part of Cigna, said they provide “temporary savings” for patients that “ultimately contribute to higher premiums or fewer benefits.”
In California, lawmakers passed a bill in 2017 limiting the use of copay coupons in the state.