Effect of Prescription Drug Coupons on Statin Utilization and Expenditures: A Retrospective Cohort Study

• Published in: Pharmacotherapy 2017-01, Vol.37 (1), p.12-24
• Main Authors: Daubresse, Matthew, Andersen, Martin, Riggs, Kevin R., Alexander, G. Caleb
• Format: Article
• Language: English
• Subjects: Adult; Aged; Copay; costs; coupons; Discount coupons; Drug Costs; Drug stores; Drug Utilization; Expenditures; Female; Health Expenditures; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Middle Aged; Prescription drugs; Prescription Drugs - economics; Prescription Drugs - therapeutic use; Retrospective Studies; statin utilization; Statins
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1002/phar.1802

Importance Drug coupons are widely used, but their effects are not well understood. Objective To quantify the effect of coupons on statin use and expenditures. Design Retrospective cohort analysis of IMS Health LRx LifeLink database. Setting U.S. retail pharmacy transactions. Participants Incident statin users who initiated branded atorvastatin or rosuvastatin between June 2006 and February 2013. Main Outcomes and Measures Monthly statin utilization (pill‐days of therapy), switching (filling a different statin), termination (failure to refill statin for 6 mo), and out‐of‐pocket and total costs. Results Of 1.1 million incident atorvastatin and rosuvastatin users, 2% used a coupon for at least one statin fill. At 1 year, compared with noncoupon users, those who used a statin coupon on their first fill were dispensed an equal number of monthly pill‐days (23.7 vs 23.8), were less likely to switch statins (14.4% vs 16.3%), and were less likely to have terminated statin therapy (31.3% vs 39.2%). At 4 years, coupon users were more likely to have switched (45.5% vs 40.8%) and less likely to have terminated statin therapy (50.6% vs 61.1%) compared with noncoupon users. Those who used greater numbers of coupons were substantially less likely to switch and terminate statin therapies. Monthly out‐of‐pocket costs were lower among coupon than noncoupon users at 1 year ($9.7 vs $15.1), but total monthly costs were qualitatively similar ($115.5 vs $116.9). At 4 years, monthly out‐of‐pocket costs among coupon users remained lower ($14.3 vs $16.6) compared with noncoupon users. Sensitivity analyses supported the main results. Conclusions Coupons for branded statins are associated with higher utilization and lower rates of discontinuation and short‐term switching to other statin products.