Check out drug coupons, then check bottom line

Special to The Times

The next time your pharmacist hands over a prescription and the bill, consider handing something back -- a coupon.

More than 200 drug coupons available online or from doctors or pharmacists have face values that could save individual consumers tens to hundreds of dollars each year.

But few patients seem to know about them. Only about 1% of the 286 billion grocery coupons distributed last year were redeemed, according to market research firm CMS Inc., but the percentage is even lower, for now, for prescription drug coupons.

Drug companies often do little marketing for the discounts, says David Harrell, chief executive of Optimizerx.com, a website launched early this year that posts links to drug coupons for consumers. The money-saving offers include not just coupons, but free trials, rebates and loyalty cards that save money on future prescriptions.

Increased marketing of the offers is likely to build awareness. Even for consumers who aren't generally coupon clippers, these offers might be worth a second look.

They might also warrant a second thought -- the savings may not actually add up.

More companies have begun to create enticements for particular brand-name drugs, partly in response to a growing number of lower-cost generic versions, says Carl Cohen, president of marketing solutions for Cegedim Dendrite, a market research firm that looks at efforts by drug companies to promote drugs to consumers. For example, Lipitor, the top-selling cholesterol-lowering drug, whose competitor, Zocor, lost its patent last summer, now has a variety of company-sponsored price cuts on its site, Lipitor.com. And of the five top-selling prescription drugs in 2006, ranked by trade publication MedADNews, three offer discount coupons.

Meanwhile, prescription coupon sites such as Optimizerx .com and Internetdrugcoupons .com, launched in July, are making it easier to find the offers. A third site, Reduceprescription costs.com, has coupon links and other tips for saving money on drugs. And some general coupon sites, such as fatwallet.com, have been adding drug coupon links as well.

By and large, the three main drug coupon sites have similar offers, though a recent check found coupons for osteoporosis drug Actonel on the first two, but not the third. And of those sites, Optimizerx is the only one to bombard users with ads. A click on a Lipitor offer, for example, also launched ads for eHealth insurance, pet medicines, drugs from Canada and a natural way to lower your cholesterol.

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Where to find them

Looking for offers? Pharmacies often have tear sheets on a bulletin board near the pharmacy or the main door. Doctors' offices may have additional information, though those deals are sometimes available only through a physician. And a drug's website usually posts such information prominently. For example, Advair, an asthma drug, offers a free prescription on its site via a message to "click here for savings."

Some offers require a bit more searching to find, such as for Diovan, a blood pressure drug. People who visit that site need to know to click on the "BP [blood pressure] Success Zone Program" link, and then search further under "program benefits." The Internet coupon sites typically do the searching for you. Click "Diovan" on Internetdrugcoupons.com, and the site explains how to get the discount offer.

Although the average grocery coupon has a face value of $1.02, according to CMS, drug offers can run far higher. Recent ones have included up to a $20 rebate on a one-month prescription of the overactive-bladder drug Detrol LA, a voucher for a seven-day supply of the sleeping pill Ambien (retail price, $35 at drugstore.com) and a free one-month supply of three breast cancer drugs.

That doesn't mean consumers should jump at every money-saving offer.

People being treated for a specific condition may not actually receive better care if they switch from their current medication to a new one simply because of a $10-off coupon. And, especially if the coupon is for one time only, the new drug could cost more in the long run.

Reading the fine print is crucial, says Matthew Tilley, head of marketing at CMS. Drug coupons cannot be used by people insured by most federal and state insurance plans such as Medicare and Medicaid (Medi-Cal in California), because the federal and state governments consider coupons a kickback to consumers. However, programs that involve no money back, such as free trials, are often allowed.

Some coupons are simply handed in with a prescription for an immediate price reduction; others, such as the offer for Detrol LA, are rebates that need to be mailed to the company along with the original receipt from the pharmacy. Wording on the coupon will explain whether it can be used for a co-pay. If so, and if the coupon's face value is higher than that of the co-pay, consumers will get only the value of the co-pay. Recent chatter on coupon blogs suggests consumers like drug coupons, with many posters saying they had found a coupon for a drug they, a child, parent or even a grandparent takes. But not everyone considers the coupons consumer-friendly. The Food and Drug Administration is planning a study of consumer perceptions of drug coupons to see if, when partnered with a drug ad, the allure of the discount keeps consumers from adequately paying attention to side effects and other risks.

Last year, the FDA posted a federal register notice asking for public comments on the proposed study. The agency has since pulled the notice, spokesman Sandy Walsh said, in order to refine the parameters of the study, but in the meantime, comments voicing opposition to coupons came into the agency. The Prescription Access Litigation Project, for example, a group devoted to lowering the cost of prescription drugs, filed comments representing 23 consumer groups calling for an outright ban on prescription drug coupons. Among the complaints: that coupons interfere with a doctor/patient relationship by leading consumers to ask their doctor for a drug for which they've seen or received a coupon, and that they deceive consumers into using high-priced brand names over generics.

"A $10 coupon is nothing compared [to] the long-term savings from using a cheaper generic drug, particularly for long-term maintenance drugs," says Alex Sugarman-Brozan, the group's director.

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When it's worth it

Still, for certain consumers, the coupons can pay off.

"Coupons are a meaningful money-saver for people whose doctor has determined that [this] is the drug they should be on," says Dr. William H. Shrank, a pharmacoepidemiologist at Harvard Medical School. "But patients should be aware that, even if they are insured, they may be charged a large amount once the coupon is used, as insurers often require high-tier co-payments for these branded drugs."

Patients interested in a coupon should determine whether a generic is available -- and then ask their physician if the generic is appropriate. Because brand-name drugs can be two to four times more expensive than generics, the brand-name drug is often more costly even if a coupon is available, says Steven Findlay, a healthcare analyst with Consumers Union.

A look at several sites turned up few drugs with coupon offers for which there was a generic equivalent, and in those cases, the coupon didn't bring the brand name down to the generic's lower price.

Synthroid, for example, a brand-name drug from Abbott Laboratories that treats thyroid hormone insufficiency, costs $13.99 per month at drugstore .com, versus $8.99 for the generic. But the coupon Abbott is now promoting only takes $3 off of each prescription, making the generic cheaper by $24 per year.

Although generic drug manufacturers rarely, if ever, offer coupons, specific insurers may. Blue Cross of California has a program called Generic Advantage, for example, which will often cover the cost of the co-pay each month if consumers choose a generic version of a drug.

And although the coupon deals may save money, consumers will almost always have to give up some privacy. Drug companies usually require personal information including name, age, address, phone number and e-mail address in exchange for the offer.

Some sites let consumers opt out of receiving additional information, but doing so can preclude getting future discount offers.

For The Record Los Angeles Times Thursday, December 06, 2007 Home Edition Main News Part A Page 2 National Desk 2 inches; 63 words Type of Material: Correction Drug coupons: A quote was misattributed to Carl Cohen of Cegedim Dendrite in a Health section article Monday on drug coupons. The observation that more companies have begun to create enticements for particular brand-name drugs, partly in response to a growing number of lower-cost generic versions, should have been attributed to Harvey Brofman, vice president of Opus Health, a division of Cegedim Dendrite. For The Record Los Angeles Times Monday, December 10, 2007 Home Edition Health Part F Page 8 Features Desk 1 inches; 38 words Type of Material: Correction Drug coupons: A quote attributed to Carl Cohen of Cegedim Dendrite in a Dec. 3 Health section article on drug coupons should have been attributed to Harvey Brofman, vice president of Opus Health, a division of Cegedim Dendrite.
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