IDENTIFYING MEANINGFUL PATIENT SAVINGS ON GENERICS: DIRECT-TO-CONSUMER PRICES VS COMMERCIAL INSURANCE
Author(s)
John K. Lin, MD1, Jenny Xiang, MD2, Xiudong Lei, PhD1, Sunita Desai, PhD3, Erin Trish, PhD4, Fumiko Chino, MD1, Meng Li, MS, PhD5, Sharon H Giordano, MD1, Ying Xu, MPH, MS, MD1, Changchuan Jiang, MD6, Jalpa Doshi, PhD7, Ya-Chen Tina Shih, PhD8;
1University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2University of Colorado Cancer Center, Aurora, CO, USA, 3NYU Grossman School of Medicine, New York, NY, USA, 4USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA, 5Tufts Medical Center, The Center for the Evaluation of Value and Risk in Health, Boston, MA, USA, 6University of Texas Southwestern, Dallas, TX, USA, 7University of Pennsylvania, Ambler, PA, USA, 8University of California Los Angeles School of Medicine, Los Angeles, CA, USA
1University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2University of Colorado Cancer Center, Aurora, CO, USA, 3NYU Grossman School of Medicine, New York, NY, USA, 4USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA, 5Tufts Medical Center, The Center for the Evaluation of Value and Risk in Health, Boston, MA, USA, 6University of Texas Southwestern, Dallas, TX, USA, 7University of Pennsylvania, Ambler, PA, USA, 8University of California Los Angeles School of Medicine, Los Angeles, CA, USA
OBJECTIVES: Direct-to-consumer (DTC) pharmacies (e.g., Mark Cuban Cost Plus Drug Company, MCCPDC) sell drugs directly to patients, aiming to help patients afford their generic prescriptions. It has been uncertain whether DTC pharmacies meaningfully save patients money, particularly for more expensive prescriptions which could otherwise be difficult to afford through commercial insurance. We evaluated the frequency and extent of potential out-of-pocket cost savings for generic prescriptions via direct cash purchase from MCCPDC compared to cost-sharing (copayment or coinsurance) through commercial insurance, stratified by cost-sharing amount.
METHODS: In this cross-sectional study, cost-sharing for filled generic prescriptions in Merative™ MarketScan® Commercial Claims Data (1/1/22-12/31/22) was compared with direct purchase prices through MCCPDC. We evaluated the frequency and extent of savings through MCCPDC, by cost-sharing categories: $0, >$0-15, >$15-25, >$25-50, >$50-100, and >$100.
RESULTS: Over 80% of all generic prescriptions were available through MCCPDC. Among generics available through MCCPDC, a large proportion of prescriptions would have lower out-of-pocket costs if filled through MCCPDC, ranging from 71% (cost-sharing category $15-25) to 93% (cost-sharing category >$100). Median potential relative savings through MCCPDC ranged from 31% (cost-sharing category $15-$25) to 87% (cost-sharing category >$100). For the most expensive prescriptions, median out-of-pocket cost was $140 through insurance versus $25 through MCCPDC. Among drugs with out-of-pocket cost-sharing >$50, fifteen drugs comprised 75.4% of total potential population-level savings through MCCPDC: these were used to treat multiple sclerosis (teriflunomide, dimethyl fumarate, and dalfampiridine), cancers (imatinib, capecitabine, and abiraterone), hypothyroidism (levothyroxine), depression (vilazodone and desvenlafaxine), erectile dysfunction (tadalafil and sildenafil), and other conditions (lamotrigine, tacrolimus, nebivolol, atomoxetine).
CONCLUSIONS: DTC pharmacies such as MCCPDC meaningfully lower out-of-pocket costs for higher-cost generic prescriptions which could otherwise be difficult to afford. Commercially insured patients should consider DTC pharmacies when their copayment or coinsurance for a generic medication exceeds $15, and particularly when it exceeds $100.
METHODS: In this cross-sectional study, cost-sharing for filled generic prescriptions in Merative™ MarketScan® Commercial Claims Data (1/1/22-12/31/22) was compared with direct purchase prices through MCCPDC. We evaluated the frequency and extent of savings through MCCPDC, by cost-sharing categories: $0, >$0-15, >$15-25, >$25-50, >$50-100, and >$100.
RESULTS: Over 80% of all generic prescriptions were available through MCCPDC. Among generics available through MCCPDC, a large proportion of prescriptions would have lower out-of-pocket costs if filled through MCCPDC, ranging from 71% (cost-sharing category $15-25) to 93% (cost-sharing category >$100). Median potential relative savings through MCCPDC ranged from 31% (cost-sharing category $15-$25) to 87% (cost-sharing category >$100). For the most expensive prescriptions, median out-of-pocket cost was $140 through insurance versus $25 through MCCPDC. Among drugs with out-of-pocket cost-sharing >$50, fifteen drugs comprised 75.4% of total potential population-level savings through MCCPDC: these were used to treat multiple sclerosis (teriflunomide, dimethyl fumarate, and dalfampiridine), cancers (imatinib, capecitabine, and abiraterone), hypothyroidism (levothyroxine), depression (vilazodone and desvenlafaxine), erectile dysfunction (tadalafil and sildenafil), and other conditions (lamotrigine, tacrolimus, nebivolol, atomoxetine).
CONCLUSIONS: DTC pharmacies such as MCCPDC meaningfully lower out-of-pocket costs for higher-cost generic prescriptions which could otherwise be difficult to afford. Commercially insured patients should consider DTC pharmacies when their copayment or coinsurance for a generic medication exceeds $15, and particularly when it exceeds $100.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE414
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas