Drug companies are prohibited from offering Medicare beneficiaries discounts on drugs. Increased use of coupons in the commercial market, however, may be artificially driving up reimbursement for Medicare Part B drugs, the Government Accountability Office reports.
Medicare pays providers to administer drugs using a formula based on drugs' average sales price. That figure does not account for coupons drug companies provide patients with private insurance, which lowers average sales prices.
Increasingly, drugmakers are using coupons as a way to help patients afford products while still maintaining the higher sticker price. This is problematic because Medicare uses the more expensive sticker price to determine providers' reimbursement, which would artificially inflate reimbursement levels, GAO said.
Last year, pharmaceutical companies that made 29 of the 50 costliest drugs in Medicare Part B offered coupons, according to GAO. It studied coupon discounts for 18 of those drugs and found 19 percent of privately insured individuals used coupons to purchase those drugs in 2013.
GAO estimated Medicare would have saved $69 million in reimbursements had it used drugs' actual market sales prices.
GAO recommended CMS investigate how much coupons lower drugs' average market prices.