JAMA
Brand drug coupons used less, but covering larger costs
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Clinical takeaway: Fewer patients are using manufacturer coupons likely due to formulary restrictions, copay accumulator programs, and shifting manufacturer strategies even as underlying costs rise, making affordability conversations even more important in practice.
Manufacturer-sponsored coupons are a common tool to offset patient costs for brand-name drugs, but new data suggest their use is declining even as their financial impact per prescription grows. This shift aligns with increasing formulary restrictions and copay accumulator programs that limit how coupons count toward deductibles.
In a national claims analysis of more than 3.2 million commercially insured patients from 2017 to 2024, investigators evaluated trends in coupon use and spending for brand-name drugs without generic competition.
Coupon use declined from 18.0% to 13.9% of patients, and among users, the share of claims covered by coupons dropped from 13.7% to 7.6%. Use fell sharply in high-cost therapeutic areas, including obesity drugs (54.6% to 2.5%) and diabetes drugs (20.8% to 8.3%), while increasing for immunomodulators (4.2% to 23.8%).
At the same time, the median coupon amount per claim increased from $60 to $90, with much larger increases for free trials (to $523 in 2024). Despite rising underlying costs, median patient out-of-pocket spending after coupons remained about $10 per prescription.
These trends suggest manufacturers may be targeting coupons more selectively while offering higher-value offsets, potentially in response to payer restrictions or higher patient cost-sharing. Coupons continue to reduce point-of-sale costs but may still steer patients toward higher-cost therapies.
“Manufacturers may be concentrating coupon programs on fewer products or for fewer patients while offering larger incentives in response to formulary pressures or expanded co-pay accumulator programs,” the study concludes. “In addition, some patients may have shifted to cash payment transactions, particularly for newer obesity drugs with variable insurance coverage.”
Source: Kang SY, et al. JAMA. April 6, 2026. Manufacturer-Sponsored Coupon Use and Brand-Name Drug Costs Among Patients With Insurance