WATCHING DRUG firms and insurers go at it over manufacturers’ coupons for high-priced brand-name drugs is like watching a grandmasters’ chess game in which patients are the pawns. But the pawns could come out ahead if the Legislature sets sensible limits on the coupons.
Drug companies want the right they have in every other state but Massachusetts — to offer consumers coupons or rebates toward the price of insurance copayments on company drugs. Insurers, who use high copayments to steer consumers to generic or lower-cost brand-name medications, see the coupons not as charity from drug firms but as a knight’s jump around their own cost-cutting efforts. Supported on this issue by advocates for broader access to health care, insurers point out that patients in other states sometimes use the coupons to start on a costly drug, only to find themselves facing the high copayments unaided once the coupons run out.
Both chambers of the Legislature have passed bills legalizing the coupons. The Senate’s is superior because it requires any coupons or rebates by drug companies to last as long as a patient is receiving the prescribed medication, including any refills. This would end any bait-and-switch use of the discounts.
The Senate bill also prohibits their use in cases where a generic equivalent of the brand-name medication is available. This should allay insurers’ concerns that the coupons will undermine their efforts to use copayment levels to control costs. With provisions like these, patients should be able to get a break on their out-of-pocket outlays for drugs with little risk that this will drive up health costs overall.