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Elizabeth D. Brouwer, MPH

Elizabeth Brouwer PDHO19
Predoctoral Fellowship in Health Outcomes, 2019 University of Washington

Characterizing Copay Coupon Use Among Specialty Drug Claims


As increasing portions of specialty drug costs are passed on to patients through specialty drug tiers, there is concern that high cost-sharing is adversely affecting patient access and adherence to essential medication. The current literature on pharmaceutical cost-sharing largely overlooks the use of copayment assistance programs, also referred to as “copay coupons,” in which drug manufacturers supplement patient out-of-pocket (OOP) costs. Because information on copay assistance is not captured in standard pharmacy claims data, its prevalence and impact are not well understood, and its omission from price-elasticity discussions likely distorts general understanding of patient behavior and incentives. This study examines copayment assistance among multiple sclerosis (MS) drug users and the effect of this assistance on drug demand in a managed care plan. Specifically, this work will characterize the prevalence of copayment assistance for users of seven MS specialty drugs and then measure price elasticity of demand using a two-part model at the patient-drug-month level. Demand will be measured by first predicting the probability of any claim and then the number of days supplied, given a claim was made. The results should inform the role of cost-sharing for specialty drugs considering industry-funded copayment assistance, and whether cost-containing strategies such as value-based insurance design could be feasibly applied to high-price specialty medications.

The PhRMA Foundation’s Predoctoral Fellowship in Health Outcomes really allowed me to focus on my dissertation while also juggling the responsibilities of motherhood. In addition, it helped me to fund data access and analyst time at a local health maintenance organization. I have been able to attend conferences to network with other researchers in the value-based insurance design field and consider different facets to my research questions.

Elizabeth D. Brouwer

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