Why Drug Coupons Exist
They lower what patients pay, but keep prices high for everyone else.
A drug can cost you $10 and still be expensive.
Drug companies say coupons help patients afford medicine. They lower out-of-pocket pharmacy costs and make it easier to start and stay on treatment.
That is partly true.
But the big picture is different.
According to a study published today in JAMA, fewer people are using coupons now. In 2017, about 18% of patients used them. By 2024, that fell to about 14%. Some drugs saw much steeper drops. For obesity drugs, coupon use went from more than half of patients to almost none.
At the same time, the remaining coupons are larger. The average value has increased. Some free trials now cover hundreds of dollars.
Patients still pay roughly the same amount: around $10.
So the price at the counter looks stable, even as the system behind it shifts.
Coupons are built to protect high prices.
In the US, drug prices are anchored to a “list price.” That figure shapes what insurers pay, what companies earn, and even prices in other countries.
Lowering the list price cuts revenue across multiple channels.
Coupons avoid that outcome.
They let companies offer discounts to some patients without changing the official price.
Coupons don’t lower prices. They decide who pays them.
Insurers are trying to control costs.
They rely on higher copays, prior authorization, and step therapy to steer patients toward cheaper options.
Coupons undercut those tools.
A drug with a high copay can still cost $10 with a coupon, removing any incentive to switch.
Insurers have started to push back. Some plans no longer count coupons toward deductibles, which reduces their value.
That is one reason fewer patients use them.
Affordability is becoming something you qualify for, not something you expect.
When cheap gets expensive.
When patients are shielded from the full price, they are more likely to use expensive drugs. Insurers still cover most of the cost, with employers and taxpayers absorbing the rest.
Over time, total spending rises.
Coupons are not disappearing. They are being used more selectively. Fewer patients receive them, but the discounts are larger.
This is a shift in strategy.
Access is narrowing.
Insurers are tightening access. Drug companies are targeting their discounts. Patients have fewer ways to reduce costs.
The system is not getting cheaper.
It is becoming more selective.
Coupons exist to preserve high prices, not reduce them.
The $10 price was never the real one.