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Invited Commentary
March 29, 2021

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

Author Affiliations
  • 1Kaiser Permanente Washington Health Research Institute, Seattle
  • 2The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
  • 3Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 4Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
JAMA Intern Med. 2021;181(6):765-766. doi:10.1001/jamainternmed.2021.0739

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.

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