Prescription drug coupons: Evolution and hidden cost in direct-to-consumer advertising

Pharmaceutical marketing in the United States had undergone a fundamental shift from targeting physicians to targeting patients through direct-to-consumer advertising (“DTCA”). Recently, attempted use of Prescription Drug Coupons (“PDCs”) DTCA claiming purported patient cost-savings, but focused on maintaining brand awareness and market share during patent expiration, has occurred, with active PDC programs currently in operation for top selling pharmaceuticals. As an example, in a simple online searches using Google we conducted from Nov 2011 – Nov 2012, we found nine of the top-10 selling drugs (90%) of 2010, which include Lipitor, Nexium, Plavix, Advair Diskus, Abilify, Seroquel, Singulair, Crestor, and Actos, had PDCs available on their manufacturers' websites. Further, the number of PDC drug product programs has proliferated rapidly, more than quadrupling from 86 in 2009 to 362 in 2012. However, this form of DTCA may be misleading to consumers and lead to both an increase in individual as well as national prescription drug expenditures. To address these negative implications, we propose targeted regulation of PDC DTCA. This would include appropriate disclosure of marketing claims, transparency in pricing of pharmaceuticals using PDCs, and disclosing clinically equivalent therapy options to promote more informed patient and physician decision-making.