Discounts are a staple of the American culture. The Sunday section of almost every U.S. newspaper has a coupon section. Reality television shows focus on people who are masters at collecting and using coupons. However, when it comes to coupons for prescription pharmaceuticals, not all Americans share the same opinion.

Recently, the New England Journal of Medicine published a Perspective Piece entitled Prescription-Drug Coupons—No Such Thing as a Free Lunch. Authors Joseph S. Ross, MD, and Aaron S. Kesselheim, MD, JD, MPH, describe how the pharmaceutical industry uses coupons to offset high co-pays for branded prescription drugs and conclude, “…physicians need to talk to their commercially insured patients about the implications of drug-coupon use and make sure that their inclination to reduce short-term out-of-pocket spending doesn’t come at the cost of higher long-term expenses for themselves and society.”

However, not all physicians feel the same. One should note that these two doctors are from Yale and Harvard, respectively—institutions that both have very restrictive policies regarding interactions with the pharmaceutical industry—and both spend a lot of time doing research (and likely a limited time seeing patients). Thus, it should not be surprising if their opinion is a bit one-sided.

In fact, just as our country seems to be split in two over many political issues, physicians also tend to have divergent views on issues surrounding the pharmaceutical industry, such as coupons. Some feel that all pharmaceutical marketing is harmful, and these dollars would be better spent on decreasing the cost of medications. These physicians tend to be younger, academic and/or work in large organizations (like the NEJM authors). However, many physicians welcome information and resources provided by the industry—especially coupons and medication samples.

Generics make up the vast majority of medications prescribed. However, many of my patients need branded medications because generics are not available (inhalers for asthma and COPD) or generics alone are not enough (diabetes in particular). Even with excellent insurance, co-pays for branded medications can be difficult for patients, especially when multiple medications are needed. Data shows that out-of-pocket costs for patients can lead to non-adherence. Thus, I (and many physicians) welcome this benefit for our patients. I will use a coupon card any time:  1) I feel a branded product is in the best interest of my patient and 2) a coupon is available.

For pharmaceutical companies using coupons, here are a few suggestions from a provider who uses them frequently:

1. Keep it simple. We recognize that there are limitations on government-sponsored plans. However, doctors and patients want to know the exact out-of-pocket cost (or at least the maximum). The “if this then that” explanations that some companies offer can get complicated. For instance, when a card says your savings can be greater than $20 and up to a maximum benefit of $50, depending on the cost of your co-pay.

2. Make it available online. I like having a physical card, but often treatment decisions are made over the phone. The same program should also be available online, and easy to find right on the product’s launch page.

3. Consider company, not product-specific coupons. Multiple plans and cards can be complex. It would be great if there were a Company X card that guaranteed co-pays no higher than $25 for its entire product line.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at www.drmintz.com.

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