BOSTON (SHNS) – Prescription drug coupon programs have expanded in Massachusetts over the past several years, according to a new analysis by a state agency that found such discounts can have implications for both spending and clinical outcomes.

A July report from the Health Policy Commission concluded that drug coupons increase use of and spending on certain drugs where lower-cost generic alternatives would be appropriate for many patients. It also found that coupons can provide financial relief and help boost adherence for patients who cannot afford medications because of high drug prices and substantial cost-sharing in their health insurance.

The commission’s report, which HPC executive director David Seltz was scheduled to present Tuesday to the Massachusetts Health Council, was required under a 2018 law that extended authorization for certain prescription drug coupons. The report says that manufacturers offer coupons almost exclusively on branded drugs, which account for 10 percent of all prescriptions dispensed in the U.S. but 79 percent of total drug spending.

“Despite the immediate benefit of drug coupons to patients, policymakers and experts debate whether and how coupons should be allowed in the commercial market given the potential relationship between coupon usage and increased spending on branded drugs versus lower cost alternatives,” the commission wrote in its report.

Massachusetts in 2012 became the last state to authorize coupon use for commercially insured patients, according to the HPC, and that 2012 law is now scheduled to sunset on Jan. 1, 2021, after being pushed back several times from its original July 1, 2015 end date. Massachusetts prohibits manufacturers from offering coupons and discounts for prescription drugs with generic equivalents that meet certain criteria.

The number of branded drugs offering coupons rose from 278 in 2012 to 701 in 2018, and uptake also increased over that time period, the HPC’s report said. Among commercial prescription fills where a coupon could have been used, the percent of claims with coupon use increased from 2.1 percent in 2012 to 15.1 percent in 2018.

Overall, according to the report, the percentage of all drug claims involving a coupon was low in 2018, at 3 percent, and the average coupon value per claim was $229.

The commission said that continued enrollment growth in high-deductible health plans, plus rising drug prices, will likely lead to more affordability challenges for patients. Without “substantial” affordability protections in place, eliminating the availability of drug coupons “would likely create serious challenges for many patients in the commonwealth,” the report found.

The commission recommended that policymakers pursue greater transparency around drug coupons and pharmaceutical pricing in general, and that payers provide transparent price information to patients so they can learn about alternative options. Payers and employers should also consider health plan designs that minimize financial barriers to care, and providers should make sure providers are aware of appropriate drug alternatives, the report said.

Also on the policy front, the report suggested that officials could consider “a range of strategies” to address high prices for prescription medications. Those strategies could include penalties for manufacturers with “excessive drug price increases,” with proceeds going toward lower copayments or other support for patients with high-priced drugs, the report said.

In November 2019, the Senate passed a drug pricing bill that proposed to regulate pharmacy benefit managers, require pharmacies to notify consumers when a lower price is available, cap out-of-pocket costs for insulin, and authorize the HPC to analyze the prices of certain drugs.