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Health Aff (Millwood). 2014 Oct;33(10):1761-9. doi: 10.1377/hlthaff.2014.0497.

Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.

Author information

Catherine I. Starner is a senior health outcomes researcher at Prime Therapeutics LLC, in Eagan, Minnesota.
G. Caleb Alexander is an associate professor of epidemiology and medicine and codirector of the Center for Drug Safety and Effectiveness at the Johns Hopkins University, in Baltimore, Maryland.
Kevin Bowen is a senior health outcomes researcher at Prime Therapeutics.
Yang Qiu is a data scientist at Prime Therapeutics.
Peter J. Wickersham is senior vice president for integrated care and specialty at Prime Therapeutics.
Patrick P. Gleason ( is director of health outcomes at Prime Therapeutics.


Expenditures for specialty drugs account for more than 25 percent of total US drug spending and have been increasing at more than 13 percent annually. We examined insurers' role in maintaining the affordability and accessibility of specialty drugs while maximizing their value. We conducted two analyses: one using an administrative claims database with information on more than ten million commercially insured patients and another using the same database combined with the drug prescription records from a specialty pharmacy. First, we examined the prevalence of specialty drug coupons and the degree to which these reduced patients' out-of-pocket costs, focusing on 264,801 prescriptions. Second, we quantified the association between the magnitude of out-of-pocket costs for specialty drugs and patients' abandonment of their new or restarted therapy, focusing on a group of nearly 16,000 patients. We found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. However, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs.


adherence; cost share; drug coupons; specialty drug managment

[Indexed for MEDLINE]

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