Monday, August 13, 2012

As Rx Coupon Debate Goes On, Massachusetts Reverses Stance


----Terri Bernacchi, PharmD, MBA, Cambria Health Advisory Professionals & Managing Partner at Quo Magis Partners

I have written a number of times on the potential benefit that drug coupon programs can afford all parties in the health care exchange, but also recognize that this is a very controversial subject. Specifically, coupons programs can benefit the manufacturer who seeks to penetrate a market, a patient who is looking for a financial benefit for a drug that the physician believes is necessary, and, if done in collaboration, can help a payer manage high-cost drugs.

Recently, Massachusetts announced that it is officially lifting its long-standing (since 1988) ban on prescription drug coupon programs. Massachusetts was the last state in the country with such a ban. Certainly, the controversial methods which make these programs very attractive to the consumer continue to stir heated debate in PBM, plan, pharmaceutical manufacturer, and regulatory circles. And those parties who hope to eliminate them have to jump a significant public relations hurdle.

You can tell from the tone of the attached article that the lifting of this ban is popular with consumers. (See link: http://www.wcvb.com/health/Massachusetts-lifts-long-standing-ban-on-prescription-drug-coupons/-/9848730/15929808/-/a3k66g/-/index.html  ) But coupons are an important and beneficial tool as health care reform gets underway and costs are shifted to the consumer, who will continue to act in his /her own perceived self-interest.

Case in point: The application of coupons in health care is not only about drug manufacturer but is also applied to provider services. In an article by Judy Wang Mayer, “Health Care Providers’ Use Of Groupon Stirs Up Controversy” on August 10, 2012, the author warns health care providers (dentists, physicians, surgeons) to be careful with social coupon websites. She says that although no providers have yet been disciplined by state licensing boards, it is “only a matter of time before most state boards of licensure and national professional associations take a position on the legality of these types of promotions. Until then, health care providers should be cautious and consult an attorney before signing up with a daily deal website like Groupon or Living Social.” (See link: http://www.mondaq.com/unitedstates/x/191090/Healthcare/Health+Care+Providers+Use+Of+Groupon+Stirs+Up+Controversy)  
A few links that are a little older that describe some of the controversy are included for the reader.
  1. A number of employers/unions (County and Municipal Employees District Council 37, American Federation of State, the Sergeants Benevolent Association, the Plumbers and Pipefitters Local 572, and the New England Carpenters) have sued pharmaceutical manufacturers in federal court over the presumed legality of these programs (March, 2012, see link: http://www.insurelane.com/insurance/blog/health/2012/03/08/Drug-Companies-Sued-By-Insurance-Plans-Over-Coupons.html)   
  2. Adam Fein, PhD, of Pembroke Consulting has written considerably on this topic and is a good source of the overall topic, including this Drug Channels article from November of 2011: http://www.drugchannels.net/2011/11/pbms-launch-new-attack-on-copay-cards.html   
  3. In the article, “Co-pay coupons: Good deal for consumers, headache for health insurance companies” by Mary Kay Jay, the author makes the case for the fact that the consumer wins while the insurance company is left to pay for a product that is many times more expensive than the generic drug they'd prefer to see be used.  http://www.netquote.com/health-insurance/news/co-pay-coupons.aspx#ixzz23SMuKDYC  

Terri is the founder of Cambria Health Advisory Professionals and a Managing Partner at Quo Magis Partners. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.