DISCOUNT DILEMMA

PERSONAL FINANCE| ADVICE

When you go to the pharmacy, you might be offered a coupon on your prescription drugs. While it may sound like a great deal, the decision to accept it is complicated.

Even as prescription drug costs rise, patients with commercial insurance slowed their use of manufacturer-sponsored drug coupons in recent years, according to a study the Journal of the American Medical Association published April 6.

These are not the same as discount card services from companies like GoodRx, which negotiate lower bulk pricing for prescription drugs, then pass those savings along to consumers.

Drug manufacturers distribute copay coupon cards to consumers to keep their drugs competitive by offering patients short-term savings. Consumers pay less out-of-pocket, often for brand-name drugs. This encourages patients to use the brand-name version, even when a cheaper, generic version might be available.

Some insurers say this unfairly puts them on the hook for pricier drugs. They say monthly premiums are higher as a result, punishing consumers and patients.

Should you use manufacturer-sponsored drug coupons? It depends.

1 What if you don't have insurance?

If you are uninsured, using a coupon can be a great way to save money, especially if there is no generic version of the drug.

TrumpRx is a new federally funded initiative that acts as a prescription drug coupon dashboard for patients. Some of the coupons come from manufacturers, while others do not; not every drug has a coupon offer.

Michelle Long, a senior policy manager at KFF who studies patient and consumer protections, said people without insurance can save money by using TrumpRx or manufacturer coupons. Still, she said, TrumpRx lists only about 85 drugs.

It is important to note drug coupons have limitations and guidelines, and they don't last forever.

2 What if you have insurance?

If the drug isn't covered by your commercial health insurance plan or if you intend to pay cash, the coupon may be the way to go.

Insurance coverage varies for certain kinds of drugs, such as GLP-1 obesity drugs. The study found coupon use by commercial insurance holders on obesity drugs dropped from 54.6% of prescriptions in 2017 to only 2.5% in 2024, though use of the drugs rose.

So-Yeon Kang — the study's main author, who is an assistant professor of health management and policy at Georgetown University — said this reflects the growing number of patients paying cash for the drugs as prices decline, along with insurers' reluctance to cover them and manufacturers' shifting focus from coupon distribution to marketing campaigns.

3 What if you expect high medical costs?

If you have insurance and anticipate meeting your deductible for the year, consider using a coupon.

However, your insurer likely won't count the value of the coupon toward your deductible. Only use a coupon if there is no generic option available and you know you'd otherwise hit your deductible.

4 What if you have a plan but low costs?

The answer is almost always: Don't use the coupon. If the drug is covered by your insurance, using coupons will put you at risk for higher indirect costs. It's also often more advantageous to spend toward your deductible.

Watch out for copay adjustment programs that insurers use to discourage use of coupons. They come in two common forms, Long said.

"Copay accumulators" allow the use of drug coupons up to their full value, but the amount of the coupon won't count toward patients' deductibles or out-of-pocket maximums, making it harder to reach the threshold at which insurers will pitch in on prescriptions and other medical care. It can also mean a patient eventually will pay the full cost of the drug because they haven't yet met their annual deductible.

"Copay maximizers," which also prevent the coupon value from counting toward deductibles, use a third party to adjust patients' copayments over the course of a year to match the amount of the manufacturers' coupons.

5 What if you're on Medicaid or Medicare?

Medicare and Medicaid beneficiaries are prohibited from using manufacturer-sponsored coupons.

A federal anti-kickback law makes it illegal to give someone anything of value to influence their decision to purchase something that will ultimately be paid for by a federal healthcare program. The law also prevents remuneration, which includes waiving copays and charging less than fair-market value for a product.

Some states, notably California and Massachusetts, prohibit or limit the use of manufacturer drug coupons when a generic version of the drug is available.

KFF health news is a national newsroom that produces indepth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.