Prescription Drug Out-of-Pocket Cost Reduction Programs: Incentives and Implications

The US spends twice as much per capita on prescription drugs compared with other high-income countries.¹ Health plans have increasingly passed these costs directly to patients as a strategy to manage utilization. A body of literature shows that increasing out-of-pocket costs is associated with a reduction in the use of both high-value and low-value drugs.² It is in this context of high drug spending for both health plans and patients that we comment on the study in this issue of JAMA Internal Medicine by Sen et al³ on prescription drug out-of-pocket cost offsets. This study’s major contribution is a careful description of the source and magnitude of offsets, with the 2 main sources being copayment coupons from drug manufacturers and discount programs from pharmacy benefit managers (PBMs) or pharmacies. These 2 sources of offsets are the product of different incentives and have different health policy implications.