Patients across the country often receive manufacturer coupons offering them deep discounts on their prescription medications. The colorful coupons flood their mailboxes and email inboxes. Discount cards can be seen strewn around the waiting rooms of their doctors’ offices. For Medicare part D patients, these coupons can harm more than they help.

Often they start out with alluring claims of saving patients thousands of dollars a year. They may offer free trials or no copays for switching to a particular brand. They mention they provide discounts on refills, or even free samples in large print and bright colors. The drug industry has increasingly relied on coupons to sell its products during the past five years: There were fewer than 100 brand-name drugs with coupon programs in 2009. Today, there are nearly 750 coupons to help patients pay for their drugs. The website, Rx Pharmacy coupons, displays links to about 700 manufacturer coupons.

The intention is to steer patients away from cheaper generic alternatives and toward the brands that they produce. Experts estimate that brand drug manufacturers are spending between $3 billion and $6 billion annually on coupon programs. However, based on an estimated return on investment of 4:1 to 6:1, it’s likely that brand manufacturers will expand their coupon programs. In fact, analysts project copayment program use may increase by 15 percent per year, meaning coupons will cover 50 percent of brand drug prescriptions — 500 million prescriptions — by 2021.. The report, which was conducted by the Office of the Inspector General of the U.S. Department of Health and Human Services, states that approximately 7 percent of Part D enrollees — 2 million people — may be using coupons.

Moreover, drug manufacturers’ programs are often designed to capture interest with low costs initially, but prices will go back to their original level once the patient no longer eligible or the program ends. These coupons often highlight the savings for patients on any insurance plan. Some manufacturers advertise support in the form of “care specialists,” who can provide claims submission assistance and certified pharmacy coordination. However, the majority of the pharmacies that they coordinate with are large chains or mail order pharmacies. Mail order pharmacies only offer to fill prescriptions in 90 day supply. This allows them to avoid contending with certain PBMs and pharmacies who would offer to fill a less costly generic that is covered in the patient’s plan.

So a Medicare patient will see an enticing discount card for medications like Symbicort, offering “new and current eligible commercially insured patients pay no more than $25 for each fill, up to 12 fills, with the savings card, including those with restrictions on prescription benefit coverage.”

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The patient follows card directions: “present the free prescription offer to your pharmacist, along with a valid prescription for SYMBICORT.” So that patient takes the card with a prescription from their doctor to the pharmacist. This is where our Medicare patient runs into a problem! The prescription can’t be filled. Why? The coupon specifically states that it is “For Cash-Paying, Medicare, and Medicaid Patients.” However, between the FREE in massive font and the Cash/Medicare/Medicaid statement is an incredibly small “subject to eligibility.” It is positioned in such a way that the eye passes over it almost completely at first glance. After some deeper digging on the SYMBICORT website, the site states “Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.” Legally, the use of drug co-pay cards and coupons by individuals with government funded health care and prescription drug benefits, such as Medicare and Medicaid, is prohibited by the federal anti-kickback statute.

Why then put it on the discount card at all if it’s illegal? There’s no stated response from the manufacturers. Is it a method to force patients to abandon their community pharmacies in frustration and push them to mail order pharmacies? That is a possible outcome, but difficult to confirm. However, re-read who this card is for: Cash-Paying, Medicare and Medicaid patients. Cash-Paying. That grouping seems odd. Or does it? Although there is no way to confirm that pharmaceutical manufacturers intentionally mislead patients into paying cash for brands with these discount cards, the best advice when dealing with these coupons is for pharmacists and patients alike to read the fine print.