How Drug Coupons Work
Manufacturer drug coupons — also called copay cards or patient savings cards — reduce the member's cost-sharing for brand drugs. A member with a $100 copay for a brand drug may pay only $10 with a manufacturer coupon — the manufacturer pays the remaining $90. Coupons are designed to maintain brand drug utilization despite high cost-sharing — and they work: members who use coupons are far more likely to continue brand drugs.
Coupon Impact on Formulary Design
Coupons undermine formulary design. A formulary that places brand drugs on Tier 3 ($100 copay) and generics on Tier 1 ($10 copay) is designed to drive generic utilization. But if the manufacturer provides a coupon that reduces the brand copay to $10, the cost-sharing differential disappears — and members have no financial incentive to use the generic.
Copay Accumulator Programs
IQ Insight
Copay accumulator programs prevent manufacturer coupons from counting toward the member's deductible. Without an accumulator program, the manufacturer's coupon payment counts toward the deductible — effectively eliminating the member's cost-sharing. With an accumulator program, the coupon payment does not count toward the deductible — the member still faces their full cost-sharing when the coupon runs out.