Copay coupons oig

The OEI Report concluded that many such measures may not actually prevent such use.

Lowering Specialty Drug Costs Through Copay Assistance and Manufacturer Coupon Programs

However, they may not be doing enough to prevent copayments going to Part D drugs. All surveyed manufacturers noted that they provide beneficiary and pharmacist notices indicating that coupons could not be used for drugs covered by Federal health care programs.

Medicare Beneficiaries Feel The Pinch When They Can’t Use Drug Coupons | Kaiser Health News

Seventy-five percent of manufacturers also had an eligibility question online or over the phone. However, OIG notes that only 3 percent had a tracking mechanism on their Web sites to prevent a patient from changing his or her answer to the eligibility question to obtain the coupon.

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OIG also criticized the size and placement of the notice of eligibility on individual co-pay cards. OIG also found the same size and placement issues for notices aimed at pharmacists. Because entities other than manufacturers cannot identify coupons within pharmacy claims, Part D plans cannot implement their own edits to stop coupon claims as they are processed.

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OIG Recommendation. Such transparency with respect to coupon use would permit all Federal health care program payors not just the sponsors of Part D plans to recognize coupon transactions. If I had commercial insurance, I could. How is this fair?

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The explanation may offer you little comfort. The coupons can lead to unnecessary Medicare spending by inducing beneficiaries to choose drugs that are expensive. Kaiser Health News is an editorially independent program of the foundation.

The coupons typically offer patients with commercial insurance a break on their copayment for brand-name drugs, often reducing their out-of-pocket costs to what they would pay for inexpensive generic drugs. The coupons help make expensive specialty drugs more affordable for patients.

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In addition, consumers should note that the copay cards often have annual maximums that leave patients on the hook for the entire copayment after a certain number of months, said Dr. Joseph Ross, associate professor of medicine and public health at Yale University who has studied copay coupons.


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If the drug is covered by Part D, there is a great possibility that the discount program could generate prohibited remuneration under the AKS if the manufacturer intends to induce or reward referrals of Federal health care program business. The AKS makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a Federal health care program.

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See 42 U. The AKS has been interpreted to cover any arrangement where one purpose of the remuneration was to obtain money for the referral of services or to induce further referrals.