Will PBMs turn copay coupons into an endangered species?

More payers are zeroing in on copay coupons and discount cards, putting this time-honored marketing technique in jeopardy. Last year, Express Scripts ($ESRX) targeted drugs with copay discounts when tossing 48 products off its national formulary. Now, UnitedHealthcare has expanded its stamp-out-coupons pilot program to cover 25 more drugs, and some smaller PBMs and insurers are making similar moves.

For drugmakers, that means copay coupons will have to be handled with care. Given the consolidation in the pharmacy benefits management world, payers have more power than ever, and they don't like it when their own cost-control strategies are circumvented by pharma marketing techniques.

Obviously, they're taking action. As Health Business Daily reports, UnitedHealthcare was pleased with the results of its coupon-elimination pilot program, launched last year with 6 drugs in mind. As of Jan. 1, another 25 meds have joined the bunch. UnitedHealthcare simply won't honor those coupons. The strictures don't apply to patients who are getting need-based copay assistance.

Meanwhile, Express Scripts is hearing kudos from its clients about its new formulary, which excludes 48 products. Adam Kautzner, the company's senior director of drug trend and formulary solutions, tells HBD that customers are asking Express Scripts to add other costly drugs to the list next year.

Prime Therapeutics and PerformRx, two smaller PBMs, say they're testing ways to block the copay coupon effect. PerformRx, for instance, says it will increase the cost difference for "nonpreferred products" to make the sure the after-coupon price for patients is still higher than the cost of its preferred drugs. For the same drugs, the after-coupon cost to payers would be the same as the cost of the preferred product. The idea is to discourage patients from using the discounts without penalizing PerformRx's payer-customers.

"The pharmaceutical industry needs to understand the fact that pushing all that they manufacture by all means is no more a marketing strategy that will be tolerated by the healthcare provider/payer community," PerformRx President Mesfin Tegenu told HBD.

- read the HBD story (reg. req.)

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