Given the high out-of-pocket costs of many prescription drugs, many patients use copay offsets to reduce their out-of-pocket costs at the point of sale. ManufacturersвЂ™ coupons were more likely to be used for expensive later-in-class-entrant products facing within-class competition where coupon use was prevalent. Drugs with a new in-class brand-name competitor had greater mean coupon use compared with drugs without a new competitor (10.2% of claims with a coupon vs 5.9%).Д¬onclusions and Relevance In this cohort study of transactional pharmacy claims, higher mean per-patient total cost within a class was significantly associated with the likelihood of coupon use, but not patient out-of-pocket cost. The intensity of coupon use was associated with later-in-class-entrant products and the class mean per-patient cost (4.16-percentage-point increase 95% CI, 1.20-7.13 0.27 per 10% increase 95% CI, 0.09-0.44). For drug characteristics, single-source later-in-class-entrant products were associated with a greater likelihood of coupon use compared with first entrants and multisource brands (OR, 1.44 95% CI, 1.09-1.89). Within a drug class, higher mean total cost per patient was positively associated with the likelihood of coupon use (odds ratio, 1.03 per 10% increase 95% CI, 1.01-1.04), but higher mean patient copay was inversely associated (OR, 0.98 95% CI, 0.97-0.99). When the manufacturer offered a coupon, it was used in a mean (SD) 16.3% (20.3%) of the transactions. Manufacturers offered a coupon for 1267 (50.7%) of these drugs. Results The sample of 2501 unique brand-name prescription drugs accounted for a total of 8вЂЇ995вЂЇ141 claims. The secondary outcome was the mean proportion of transactions in which a coupon was used for each product. Main Outcomes and Measures The primary outcome was availability of a manufacturerвЂ™s coupon. Data were analyzed from September 2020 to February 2021. Objective To examine whether the following factors are associated with manufacturer drug coupon use: (1) patient-cost characteristics (mean per-patient cost per drug, mean patient copay) (2) drug characteristics (generics availability or вЂњlater-in-class-entrantвЂќ drugs) (3) drug-class characteristics (in-class coupon use among competitors in-class generic competition in-class mean cost and copay).Дesign, Setting, and Participants This was a retrospective cohort analysis of anonymized transactional pharmacy claims sourced from retail US pharmacies from October 2017 to September 2019, supplemented with information derived from Medi-Span, Red Book, and FDA.gov. Importance Drug companies offer coupons to lower the out-of-pocket costs for prescription drugs, yet little is known about why they do so for some drugs but not for others. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.

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