Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Health Forum. 2021 Aug 13;2(8):e212123. doi: 10.1001/jamahealthforum.2021.2123. eCollection 2021 Aug.
Drug companies offer coupons to lower the out-of-pocket costs for prescription drugs, yet little is known about why they do so for some drugs but not for others.
To examine whether the following factors are associated with manufacturer drug coupon use: (1) patient-cost characteristics (mean per-patient cost per drug, mean patient copay); (2) drug characteristics (generics availability or "later-in-class-entrant" drugs); (3) drug-class characteristics (in-class coupon use among competitors; in-class generic competition; in-class mean cost and copay).
This was a retrospective cohort analysis of anonymized transactional pharmacy claims sourced from retail US pharmacies from October 2017 to September 2019, supplemented with information derived from Medi-Span, Red Book, and FDA.gov. Data were analyzed from September 2020 to February 2021.
The primary outcome was availability of a manufacturer's coupon. The secondary outcome was the mean proportion of transactions in which a coupon was used for each product.
The sample of 2501 unique brand-name prescription drugs accounted for a total of 8 995 141 claims. Manufacturers offered a coupon for 1267 (50.7%) of these drugs. When the manufacturer offered a coupon, it was used in a mean (SD) 16.3% (20.3%) of the transactions. Within a drug class, higher mean total cost per patient was positively associated with the likelihood of coupon use (odds ratio [OR], 1.03 per 10% increase; 95% CI, 1.01-1.04), but higher mean patient copay was inversely associated (OR, 0.98; 95% CI, 0.97-0.99). For drug characteristics, single-source later-in-class-entrant products were associated with a greater likelihood of coupon use compared with first entrants and multisource brands (OR, 1.44; 95% CI, 1.09-1.89). The intensity of coupon use was associated with later-in-class-entrant products and the class mean per-patient cost (4.16-percentage-point increase; 95% CI, 1.20-7.13; 0.27 per 10% increase; 95% CI, 0.09-0.44). Drugs with a new in-class brand-name competitor had greater mean coupon use compared with drugs without a new competitor (10.2% of claims with a coupon vs 5.9%).
In this cohort study of transactional pharmacy claims, higher mean per-patient total cost within a class was significantly associated with the likelihood of coupon use, but not patient out-of-pocket cost. Manufacturers' coupons were more likely to be used for expensive later-in-class-entrant products facing within-class competition where coupon use was prevalent.
制药公司提供优惠券以降低处方药的自付费用，但对于他们为何为某些药物提供优惠券而不为其他药物提供优惠券，人们知之甚少。
研究以下因素是否与制造商药品优惠券的使用有关：（1）患者费用特征（每种药物的每位患者平均自付费用，每位患者平均共付额）；（2）药物特征（仿制药的可用性或“同类后期进入者”药物）；（3）药物类别特征（同类竞争产品中的优惠券使用情况；同类仿制药竞争；同类产品的平均成本和共付额）。
设计、设置和参与者：这是一项回顾性队列分析，对 2017 年 10 月至 2019 年 9 月期间从美国零售药店获取的匿名交易性药房索赔进行分析，并辅以 Medi-Span、Red Book 和 FDA.gov 提供的信息。数据于 2020 年 9 月至 2021 年 2 月进行分析。
主要结果是制造商优惠券的可用性。次要结果是每种产品使用优惠券的交易的平均比例。
2501 种独特的品牌处方药共产生 8995141 份索赔。制造商为 1267 种（50.7%）此类药物提供了优惠券。当制造商提供优惠券时，它在平均（SD）16.3%（20.3%）的交易中使用。在一个药物类别中，每位患者的总费用越高，使用优惠券的可能性就越大（优势比[OR]，每增加 10%，为 1.03；95%置信区间[CI]，1.01-1.04），但每位患者的共付额越高，使用优惠券的可能性越低（OR，0.98；95%CI，0.97-0.99）。对于药物特征，同类后期进入者的单一来源产品与第一代和多来源品牌相比，更有可能使用优惠券（OR，1.44；95%CI，1.09-1.89）。优惠券的使用强度与同类后期进入者产品和同类产品每位患者的平均费用（增加 4.16 个百分点；95%CI，1.20-7.13；增加 0.27 个百分点；95%CI，0.09-0.44）有关。具有同类新品牌竞争药物的优惠券使用率明显高于没有新竞争药物的药物（使用优惠券的索赔占 10.2%，而没有新竞争药物的索赔占 5.9%）。
在这项基于交易性药房索赔的队列研究中，同一类别内每位患者的平均总费用与使用优惠券的可能性显著相关，但与患者自付费用无关。制造商更有可能为昂贵的同类后期进入者产品提供优惠券，这些产品面临着同类竞争，而在这些竞争中优惠券的使用更为普遍。
