Extreme Couponing

A typical scenario that I encounter in retail pharmacy regularly goes something like this: patient comes up to the counter, lets me know that they have a new prescription to drop off, they would like to pick it up at certain time, and I get working on it. Easy enough. But more often than not lately the scenario goes a little more like this: patient comes up to the counter, they have a new prescription, they'd like to come back at a certain time, but ALSO, they have a coupon for the new medication that they have been prescribed. Many of the coupons that I have been seeing lately include ones for Suprep bowel kits for patients who are going to be receiving colonoscopies, Lipitor drug cards, Finacea drug cards, Accutane and Clarvis drug cards, Benicar drug cards, Vyvanse drug cards and other CII drugs, Androgel pump drug cards, and many many others. Where are these patients getting these coupons? They're getting them from multiple different sources actually, including:

• Mainly their doctors when they get a new prescription, and where do the doctors get them from? From their drug representatives 
• From drug stands at the doctors office
• Magazines
• Mail
• See different ads on television for them
• Internet and others

So what's the problem? These patients are just trying to save money on their new prescriptions, so it's a good deal for them. Well actually there are many different problems that these coupons can cause, and most of them unfortunately are cost-based. One of the first problems that the technicians and pharmacists encounter with these coupons is that many times they actually DON'T benefit the patient more than their insurance already does, but for many of the coupons or drug cards they act as a form of secondary insurance, picking up whatever the primary doesn't cover. Another way that many of these cards work is by giving the patient a "maximum" dollar amount that they will have to pay, like with the Lipitor drug cards their selling point is, "Pay NO more than $4.00 for your Lipitor prescription!" Which for anyone in retail pharmacy they know that Lipitor is rather expensive with or without insurance, but there's a generic available. Which then leads to another question and problem, if there is a generic available, and no DAW code written on the prescription, then why are the patient and the Doctor wanting the brand name drug? The main reason behind this is the generic is cheaper than the generic, but not necessarily with that coupon or drug card that they have brought into the pharmacy. If the generic is usually $7.00 a month and they can get it for $4.00 a month, they're going to opt for the cheaper option obviously. But what does that mean for pharmacies and insurance companies, and in the long run, unbeknownst to the patient, the patient themselves. First off the pharmacies, the pharmacy is going to most likely lose money by using this drug card because of their average wholesale price. They're most likely paying a certain dollar amount from the warehouse they get their medications ordered from, and they charge a set amount, which their cost to the customer usually covers. However, when patients use these drug cards it lowers their usual cost and the pharmacy ends up losing anywhere from $3.00 to $80.00 or even more. So by letting these customers use these drug cards we're actually losing money per customer, which adds up, regardless of whether or not they have other medications that they pay full price for. So then the question sadly becomes, is their service worth it? Should we continue to let these customers come to the pharmacy? Would the pharmacy rather have the clientele or save money that they could then use to hire another technician? The next thing to think about is the insurance companies, which in turn by having these coupons given out are losing money to each patient who chooses to use a coupon or drug card. And how do they decide to fix this problem? By increasing the customers premiums, and in the long run charging them more each year, so in many cases the customer is not actually saving money by using these coupons but paying more at the end of each year. So what are pharmacies to do? Turn down the customer if they try to use a coupon and lose the business? No, that's not a reasonable approach, but neither is pumping out large amounts of coupons for medications that could easily be replaced with generics or paid for in general. Many doctors get these coupons from their drug representatives who are trying to get their products out onto the market, and they're usually brand name expensive drugs, not to mention doctors will give these medications out to their patients when they don't know enough about them. So until the insurance companies, pharmacies, doctors offices, and drug reps come to a consensus on how they're going to use these coupons and when it benefits the customer and companies to use these, we're going to continue using and spending money where it shouldn't be spent.

Information about drug coupon use and insurance companies can be found at :
http://www.kaiserhealthnews.org/stories/2012/october/02/drug-coupons.aspx?referrer=search