Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business (the coupons are not allowed for Medicaid and Medicare). Now, it appears the limb broke, and the company has essentially decided to backtrack.

The mammoth health benefits company announced on the broker section of its website in March that it would partner with its retail pharmacies to discontinue the use of the copay coupon offsets. On April 11, UnitedHealth said it had decided at this time not to implement the new initiative, which was to have begun in July of this year.

So what happened to prompt the change? UnitedHealth has not publically discussed the reasoning behind its latest decision, but there are at least two triggers:

  • The partnership with retail pharmacies might not have actually been much of a partnership. While UnitedHealth has the clout and perhaps the contract terms to dictate business practices at the retail end, the likes of Walgreens and CVS might not have been too keen on the dictate. Patients and their advocates have grown quite fond of copay coupons despite their unpopularity with some payers. Patients know that the coupons help them afford medications they like, regardless of their preferred or non-preferred status. For pharmacy chains, coupon use likely means additional Rx volume and store revenue.
  • Employers may have also cried foul. They're footing the bill, after all, and they may fear member disruption and backlash.  Some workers could be more compliant on a drug with a non-preferred status or believe that the couponed drug better treats their condition.

UnitedHealthcare is not afraid to rock the boat, so this issue will not go away. The company has already taken the lead over the past few years to block coverage of copay coupons associated with certain specialty drugs.  This July, United is also planning to exclude several primary-care drugs from formularies serving many of its members (although, like Express Scripts, they have chosen many categories that still give consumers multiple options). The company's move comes at a time when all players in Rx management are working to understand appropriate access for not only small-molecule drugs but for specialty drugs with hefty price tags. Pharma manufacturers are likely already rethinking their coupon strategy and working with insurers and PBMs on more innovative approaches to economical access.

Follow Jane DuBose on Twitter @JaneGDuBoseDRG


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