Trends in Manufacturer Coupons for Biologics: Decline in Use Despite Higher Per-Claim Value

The use of manufacturer-sponsored coupons for biologics has declined among insured patients since 2018, despite per-claim coupon amounts increasing, according to a research letter recently published in JAMA.¹

Manufacturer-sponsored coupons are widely used to reduce out-of-pocket costs for patients on numerous brand-name prescriptions. However, despite the initial cost savings for patients, these coupons can undermine formulary incentives by insurers, like cost sharing, preferred drug status, or utilization management to control costs.¹ Other studies have also suggested manufacturer coupons to be associated with product hopping—encouraging patients to switch to a newer version of a drug just before the cheaper biosimilar alternatives become available—thus distorting biosimilar competition.²

This research letter aimed to monitor trends in manufacturer-coupon use, as evidence remains limited on how these trends impact patients’ out-of-pocket costs and overall health care utilization.¹

Researchers analyzed 105 person-level samples of pharmacy claims from the IQVIA Formulary Impact Analyzer. This data-analysis tool captures approximately 58% of US retail pharmacy transactions.

Patients assessed in this research were those who had commercial insurance and at least 1 claim for a brand-name drug without the generic competition between January 1, 2017, and December 31, 2024. Product-specific manufacturer coupons were categorized by use as either the primary payer (free trials) or the secondary payer (co-pay assistance).

The primary outcome was annual patient-level coupon use, defined as 1 or more coupon-covered pharmacy claims per year. The secondary outcomes assess the coupon amount per claim and patient out-of-pocket spending with and without coupon offsets.

There were 3,243,061 patients with commercial insurance with 55,325,139 pharmacy claims for brand-name, single-source drugs, included in the analysis. Between 2017 and 2024, there was a decline in patient-level coupon use from 18.0% to 13.9% (P < .001).

The adjusted logistic regression model showed the probability of coupon use was also significantly lower in 2024 than in 2017 (−3.9 percentage points [95% CI, −5.4 to −2.4]; P < .001). For patients who used manufacturer-sponsored coupons, the percentage of pharmacy claims covered by coupons per patient also declined from 13.7% (95% CI, 13.6%-13.8%) in 2017 to 7.6% (95% CI, 7.5%-7.6%) in 2024 (P < .001).

The researchers noted that manufacturer-sponsored coupon use also declined notably for obesity therapies, from 54.5% in 2017 to 2.5% in 2024, and for diabetes therapies, from 20.8% in 2017 to 8.3% in 2024. Researchers suggest that the decline could be in tandem with decreased utilization of glucagon-like peptide-1 receptor agonists (GLP-1 RA).¹ However, prior research shows that total US spending on GLP-1s has increased by more than 500% from 2018 to 2023 to keep pace with demand.³

In contrast, manufacturer-sponsored coupons for immunomodulators—used to treat various diseases and conditions like multiple sclerosis or rheumatoid arthritis and other autoimmune diseases—increased from 4.2% in 2017 to 23.8% in 2024.¹

However, despite decreased utilization of manufacturer-sponsored coupons, the median coupon amount per pharmacy claim increased from $60 (IQR, $30-$150) in 2017 to $90 (IQR, $35-$221) in 2024. In 2024, the median coupon amount was $523 (IQR, $155-$707) for free trials and $65 (IQR, $30-$150) for co-pay assistance. Patient out-of-pocket costs remained stable throughout the period.

This research letter was limited by the nature of descriptive analysis and the inability to distinguish manufacturer behavior from payer-imposed restrictions or other policies. Additionally, brand-name drugs with generic competition, patients without commercial insurance, and patients who self-pay for prescription drugs were not included.

“Reductions in coupon use without viable affordability alternatives may increase financial barriers, underscoring the need for policies that balance patient affordability with broader market incentives,” the authors concluded.

References

1. Kang S, Kim M, Levy JF, Hermosilla M. Manufacturer-sponsored coupon use and brand-name drug costs among patients with insurance. JAMA. Published online April 06, 2026. doi:10.1001/jama.2026.2620

2. Gibbons JB, DiStefano M, Anderson GF, Kesselheim AS, Socal M. Brand manufacturer coupons and pharmaceutical product hopping. JAMA Netw Open. 2026;9(3):e262201. doi:10.1001/jamanetworkopen.2026.2201

3. Tsipas S, Khan T, Loustalot F, Myftari K, Wozniak G. Spending on glucagon-like peptide-1 receptor agonists among US adults. JAMA Netw Open. 2025;8(4):e252964. doi:10.1001/jamanetworkopen.2025.2964