{ "id": "R44264", "type": "CRS Report", "typeId": "R", "number": "R44264", "active": true, "source": "CRSReports.Congress.gov, EveryCRSReport.com", "versions": [ { "source_dir": "crsreports.congress.gov", "title": "Prescription Drug Discount Coupons and Patient Assistance Programs (PAPs)", "retrieved": "2022-10-21T04:04:50.496657", "id": "R44264_6_2022-09-12", "formats": [ { "filename": "files/2022-09-12_R44264_97bc9b918284292958bf5abf53f8d89c7d8fb023.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R44264/6", "sha1": "97bc9b918284292958bf5abf53f8d89c7d8fb023" }, { "format": "HTML", "filename": "files/2022-09-12_R44264_97bc9b918284292958bf5abf53f8d89c7d8fb023.html" } ], "date": "2022-09-12", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R44264", "type": "CRS Report" }, { "source": "EveryCRSReport.com", "id": 462030, "date": "2017-06-15", "retrieved": "2018-05-10T13:10:53.149465", "title": "Prescription Drug Discount Coupons and Patient Assistance Programs (PAPs)", "summary": "U.S. pharmaceutical manufacturers fund a variety of programs to help consumers defray the cost of prescription drugs. Industry assistance includes drug discount coupons, as well as free drugs and cost-sharing payments for individuals with lower incomes or high medical expenses. According to one analysis, drug manufacturers tendered discount coupons for more than 600 brands in 2016. Nonprofit patient assistance programs (PAPs) offered by drug manufacturers and independent charities dispense billions of dollars in assistance annually, placing them among the nation\u2019s largest charitable organizations.\nDrug manufacturers say the generous aid is evidence of their commitment to patients who cannot afford a prescribed course of medication. Many manufacturer programs are designed to reduce consumer cost sharing for high-cost specialty drugs used to treat cancer, hepatitis C, Crohn\u2019s disease, and other serious conditions. Industry analysts and the Department of Health and Human Services\u2019 Office of Inspector General say that the programs also are used to bolster prescription drug sales and prices and can increase costs for government and commercial health payers. For example, an insured consumer may use a manufacturer coupon to buy a more expensive brand-name drug even if a lower-cost generic is available. Although the coupon reduces the consumer\u2019s cost-sharing obligation for the drug, it does not cut the price paid by the consumer\u2019s health care plan.\nFederal statutes, including an anti-kickback law, limit the use of coupons and manufacturer donations in conjunction with federal health care programs, such as the Medicare Part D prescription drug benefit. The anti-kickback law in Section 1128B(b) of the Social Security Act prohibits the knowing and willful offer or payment of remuneration to induce a person to buy an item or service that will be reimbursed by a federal health care program. In the private sector, some health plans have barred their enrollees from redeeming coupons for certain drugs or have chosen not to cover certain drugs that qualify for coupon discounts. Other health plans allow or encourage enrollees to redeem coupons for expensive drugs to improve the odds that the enrollees will complete a prescribed course of treatment. \nThis paper provides background on prescription drug coverage and consumer spending and on the role played by coupons and PAPs.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44264", "sha1": "9096617ce56cdeef822130ed447f54eca3e5435e", "filename": "files/20170615_R44264_9096617ce56cdeef822130ed447f54eca3e5435e.html", "images": { "/products/Getimages/?directory=R/html/R44264_files&id=/1.png": "files/20170615_R44264_images_0c93b56c469bf850b4f0010393165556613ab01c.png", "/products/Getimages/?directory=R/html/R44264_files&id=/0.png": "files/20170615_R44264_images_8681a692b4237dcb0e49b8fa1b6637d830f47e69.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44264", "sha1": "1620b32a24a5e7e0bd6150be54c139fc134c4ab2", "filename": "files/20170615_R44264_1620b32a24a5e7e0bd6150be54c139fc134c4ab2.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" }, { "source": "IBCList", "id": 4863, "name": "Health & Medical R&D" }, { "source": "IBCList", "id": 4880, "name": "FDA Product Regulation & Medical Research" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 447064, "date": "2015-11-05", "retrieved": "2016-04-06T18:00:30.074832", "title": "Prescription Drug Discount Coupons: Implications for Public and Commercial Health Care Plans", "summary": "U.S. pharmaceutical manufacturers offer co-payment coupons to consumers with health insurance to help defray the cost of prescription drugs. Drugmakers offer the coupons on corporate websites, in physician offices, and through television and other media to create a market for a newly introduced drug, to increase the likelihood that a patient will continue an existing prescription, or to bolster the market for brand-name drugs that have lost patent exclusivity and face competition from lower-priced generic substitutes. Coupons can be especially important to individuals who have been prescribed expensive specialty drugs to treat cancer, hepatitis C, and other serious conditions.\nThe number of pharmaceutical coupon offers has increased in recent years, with manufacturers tendering coupons for more than 500 prescription drugs in 2014, compared with fewer than 100 in 2011. According to one study, coupons were used for about 8% of brand-name prescriptions in 2014, up from 3% in 2011. While manufacturer coupons may reduce or eliminate a consumer\u2019s out-of-pocket spending requirement, generally they do not reduce the price an insurer or government program is charged for a drug. Health care payers, such as commercial insurers, unions and employers, and government programs, say that coupons can actually increase their costs if enrollees use them to buy more expensive brand-name drugs when cheaper generics or other substitute drugs are available. \nIn addition to offering coupons, manufacturers and charitable organizations run pharmaceutical assistance programs that provide free drugs and other aid to consumers who may not have insurance or are unable to afford a prescribed drug. Retail drugstores and other businesses also offer their own discount cards and customer-incentive programs to increase demand.\nCoupon use is prohibited in conjunction with federal health programs such as the Medicare Part D prescription drug benefit. Federal statutes, including antikickback law (Section 1128B (b) of the Social Security Act), prohibit the knowing and willful offer or payment of remuneration to induce a person to buy an item or service that will be reimbursed by a federal health care program. Manufacturers may be liable under the antikickback statute if they offer coupons to induce consumers to purchase drugs under federal programs. In a September 2014 audit, the Department of Health and Human Services\u2019 Office of Inspector General found that manufacturers did not have consistent controls in place to prevent Medicare enrollees from using prescription drug coupons in conjunction with their Part D benefits. \nIn the private sector, some payers have begun to bar enrollees from redeeming coupons for certain prescription products or have chosen not to cover certain drugs that qualify for coupon discounts. Others allow or encourage enrollees to redeem coupons for expensive specialty drugs to improve the odds that the enrollees will complete a prescribed treatment. Studies have shown that enrollees are less likely to adhere to a full course of medication when out-of-pocket payments increase.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44264", "sha1": "25eef29969ac3f238cfd0f310677c9a2a153b8ab", "filename": "files/20151105_R44264_25eef29969ac3f238cfd0f310677c9a2a153b8ab.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44264", "sha1": "cc230c6ca7301b5df95d1210de9d33ca46c9b64d", "filename": "files/20151105_R44264_cc230c6ca7301b5df95d1210de9d33ca46c9b64d.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2177, "name": "Medicare" }, { "source": "IBCList", "id": 2678, "name": "Medical Product Regulation" } ] } ], "topics": [ "Health Policy" ] }