Insurers, PBMs Take Varied Approaches to Addressing Specialty Drug Copay Coupons, Drug Benefit News Reports

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The latest issue of Drug Benefit News takes a look at how insurers and PBMs are using copay coupons to boost adherence to specialty drugs.

Many health plans and PBMs agree that copay coupons offered by makers of traditional brand-name drugs thwart formulary compliance, and have attempted to combat their use through tactics such as enlarging copay differentials and applying utilization management. But when it comes to coupons and discount programs associated with high-cost specialty drugs, payers are taking a more selective approach, Atlantic Information Services’ Drug Benefit News (DBN) reports in its Oct. 25 issue, as these programs may improve medication compliance by offsetting a patient’s financial responsibility.

The specialty realm presents medication compliance and therapy abandonment concerns that are closely tied to cost share, which is often higher for specialty drugs, even preferred agents, Pat Gleason, director of health outcomes at Prime Therapeutics LLC, tells DBN. “I understand the philosophy of ‘there’s more skin in the game’ [with higher cost share]. But then you’ve got the corollary issue of, as you get above $150 a month, people may choose to abandon therapy and that’s not what we want,” says Gleason. “We want to help people get the medicine they need to feel better and live well.”

As a result, Prime currently allows the use of coupons and patient assistance programs (PAPs) for both preferred and non-preferred specialty agents, and recently quantified members’ cost savings associated with those discount programs.

Visit to read the article in its entirety, which includes results from research presented by Prime and an overview of analysis presented by UnitedHealthCare at the Academy of Managed Care Pharmacy’s Nexus 2013 conference held earlier this month.

About Drug Benefit News

Published biweekly, Drug Benefit News delivers timely news and proven cost management strategies for health plans, PBMs, pharmaceutical companies and employers. Coverage includes up-to-the minute news of industry consolidation, strategies for participation in exchanges, generic promotion tactics, formulary decisions, innovative benefit designs, drug pricing methodologies, PBM contracting, changes in Part D and other federal initiatives, and much more. Visit for more information.

About Atlantic Information Services

Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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Jill Brown, Executive Editor
Atlantic Information Services
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