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    Coping with patients who come bearing coupons



    No coupons under Medicare...supposedly

    Federal law prohibits the use of copayment coupons by participants in Medicare and Medicaid, treating them as kickbacks. Nonetheless, according to Dafny, about 6% of Medicare enrollees do redeem coupons despite the illegality. 


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    Manufacturers are supposed to make clear through prominent warnings on the coupons themselves that their use is forbidden for Medicare and Medicaid recipients. Manufacturers can be prosecuted for failure to include such clear warnings. Pharmacies can also be held liable for such misuse of coupons. 

    In 1988, the state of Massachusetts banned use of copayment coupons, but the state repealed that ban in 2012 due to consumer pressure. In recent years, scores of organizations representing consumers, seniors, labor unions, nonprofit health plans and other interest groups have aligned themselves with health insurers to oppose coupon use. Meanwhile, despite that opposition, the use of coupons in the healthcare marketplace has continued to expand. According to Managed Care magazine, 86 copayment coupon programs existed in 2009, and by 2012 coupon programs existed for more than 370 drugs. In 2016, the NEJM authors describe the availability of coupons as “rampant.”

    In each clinical encounter, a physician has an opportunity to act in the best interests of an individual patient in a particular situation. Sometimes, in the short run, it seems that may mean condoning the use of a copayment coupon.

    However, Derrow, who rarely uses coupons, says that because coupon use leads to higher premiums over the long haul, he ordinarily talks with his patients who would do well on low-cost, high-value drugs about using them instead of a costly new medicines. Choosing high value medications, he says, is usually best for his patients, and also saves the system as a whole a lot of money.


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