Prescription Drug Coupons Bad for Patients

Tim | November 2, 2010

Prescription-drug sales using coupons that can reduce or eliminate co-payments more than tripled in the past four years, prompting safety concerns from regulators and complaints from benefit managers.

Use of coupons, vouchers and discount cards rose 258 percent in the 48 months ended in July, pharmacy-sales data compiled by consultant IMS Health show. Promotions rose most for cholesterol drugs such as Pfizer Inc.’s Lipitor and AstraZeneca Plc’s Crestor, said benefit manager Express Scripts Inc.

The prospect of saving hundreds of dollars may inflate expectations about a product and obscure health risks, the Food and Drug Administration said last month in announcing an investigation into coupons and consumer behavior.

Coupons may encourage patients to buy more expensive drugs, say consumer groups and Express Scripts, which is charged with cutting prescription costs for employers and insurers. Lipitor is the world’s top-selling prescribed drug, outpacing generics that sell for less than one-fifth the price.

Makers of name-brand drugs “know what they’re doing,” said Bill Vaughan, a senior analyst with Consumers Union, an advocacy group in Washington that opposes prescription coupon use. “It’s not Santa Claus.”

With Lipitor and Crestor patents set to expire in the next two years, coupons have become available on websites and as discount cards that drugmakers give physicians to pass on to patients.

Kristen Neese, a Pfizer spokeswoman in New York, didn’t respond to e-mail requests for comment. AstraZeneca, based in London, referred questions to its Washington trade group, the Pharmaceutical Research and Manufacturers of America.

“Affordable access to medicines is critical to patient care and the country’s overall health,” Wes Metheny, senior vice president of the trade group, said in an e-mail.

Drugmakers now aim marketing at patients rather than physicians because consumers can go online to explore treatment options, said Everett Neville, chief trade relations officer at Express Scripts.

“The decision is 30 percent doctor, 30 percent advertising, 30 percent what the patient asks for,” Neville said. Drugmakers “now see that the patient has a more active role in the drugs they’re choosing,” he said.

Express Scripts, based in St. Louis, discourages use of coupons for medicines that have generic counterparts because that drives up costs for employers and insurers, who are its clients.

A 30-day supply of 20-milligram Lipitor tablets costs $135 and a comparable quantity of Merck & Co.’s cholesterol-lowering Vytorin is $122. Similar generics are $28 and $23, according to Prescription Access Litigation, a Boston-based advocacy group.

Consumer Reports Health Best Buy Drugs, operated by Consumers Union, recommends generic cholesterol-lowering drugs except if a patient has had a heart attack, chest pains or “bad” cholesterol that needs to be lowered more than 30 percent.

Lipitor’s patent will expire next year. Data from IMS Health shows $92 billion of drug sales may face competition from generic equivalents through 2014.

Coupons can create “expectations in the patients’ minds that are consumer driven rather than health related,” said Wells Wilkinson, the project’s director.

The FDA is trying to measure how much discounts influence consumer behavior and expects to have results in 2012, said Shelly Burgess, a spokeswoman. The agency plans to interview 10,000 people online and in-person and measure response to different promotions, such as free trial offers and money-back guarantees.

BLOOMBERG NEWS: Massachusetts is the only state to prohibit prescription coupon use. Wells’ group helped defeat legislative efforts to lift the ban in the past two years.

Government regulation can lead to unintended consequences, Express Scripts’ Neville said. His company requires patients to use generics when available, or cover 100 percent of the cost of the brand-name drug.

Coupons are sometimes available for specialty drugs with no generic equivalent, such as Teva Pharmaceutical Industries Ltd.’s multiple sclerosis drug Copaxone.

Patients who take specialty drugs may have to pay 10 to 20 percent of costs that can be as much as $5,000 a month, Neville said. Drugmakers in those cases aren’t trying to hook a patient on a name-brand treatment, “they’re just helping the member get their medicine,” he said.