Pharmaceutical Markets

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I feel pharmacy co-payment coupons are beneficial for patients, but they are not necessarily attractive for all stakeholders in the society e.g., health plans sponsors or insurers or payers. This argument is especially true for expensive biologic medications that have high co-insurance/copays.

The most important benefit to the patient is that it lowers their out-of-pocket expenses. It reimburses patients with prescription-drug coverage for the cost of their copay if they choose the higher-priced brand drug instead of the option preferred by their plan sponsor. [1] For low-income or elderly individuals that are barely making ends meet, such help from the pharmaceutical manufacturers goes a long way. In some cases, it would even mean patients are able to buy food and prescriptions, not one of these.

A clinical/health benefit is that it may increase adherence to the medication i.e., they would be less likely to abandon the medication and stay on-therapy longer and better manage their disease or condition. [2] For terminal illnesses, it would mean that patients could stay alive because they were able to access the ‘life-saving’ medication.

However, such co-pays are not favored by the insurers as they undermine the utilization and cost-controlling programs that health plan sponsors have implemented. [2] On the contrary, these programs are not only implemented to control health plan costs, but they also encourage patients to use cost-effective drugs based on the health plan’s assessment, but not necessarily the pharmaceutical manufacturers.

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