Baltimore, MD—When drug manufacturers respond to complaints of high pharmaceutical product costs, they usually discuss the vouchers and coupons they offer to defray patients’ out-of-pocket drug expenses.

A new study from researchers at the Johns Hopkins Bloomberg School of Public Health found, however, that the price reductions, while they significantly reduce patient costs, tend to be concentrated among a small number of drugs and are usually not targeted to patients who are most desperate for financial relief.

The report in JAMA Internal Medicine discusses results of the study, which involved analysis of tens of millions of pharmacy transactions by more than 600,000 drug purchasers in the United States during 2017-2019.

The study team sought to better understand how vouchers and other point-of-sale copayment “offsets” are used. Complicating the review, according to the authors, is that those coupons and vouchers can come in many forms: offered online directly to customers, provided by pharmacy chains, through “drug-discount cards,” or accessible in smart phone apps.

The 631,249 purchasers in the study, mean age 45.7 years, had about 33 million prescription fills, with an offset used in 12.8% of them. Of those, 50.2% originated from a pharmaceutical manufacturer, 47.2% originated from a pharmacy or pharmacy-benefit manager (PBM), and 2.6% originated from a state assistance program.

Most, 80%, of manufacturer-sponsored offsets were concentrated among 6.2% of unique products, and 79.9% of pharmacy-PBM offsets were concentrated among 4.9% of unique products.

In addition, the study determined, most manufacturer offsets (88.2%) were for branded products, while most pharmacy-PBM offsets were for generic products (90.5%). Disease categories for which offsets for branded drugs were most available—including diabetes, lung disease, and cardiovascular disease—are common, however,

In terms of savings, the median manufacturer offset was $51.00, covering 87.1% of out-of-pocket costs, while the median pharmacy-PBM offset was $16.30, covering 39.3% of out-of-pocket costs. In fact, study authors found, more than a third, 35.4%, of manufacturer offsets fully covered the patient’s out-of-pocket costs, compared to just 0.8% for pharmacy/PBM offsets.

“There was no meaningful association between offset magnitude and county-level income, health insurance coverage, or race/ethnicity,” the authors point out, adding that the offsets “were generally not more generous among individuals in counties with lower income or larger Black or uninsured populations.”

“The most significant finding was that these offsets are not being targeted to people who likely need them the most—for the pharmaceutical company-sponsored offsets, the goal may be mainly to maintain market share,” added lead author, Aditi Sen, PhD, assistant professor in the Department of Health Policy and Management at the Bloomberg School. “Understanding different offset types and which patients use them is important for designing policy.”

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