![]() These findings are less pronounced than a prior study that found that a similarly limited coupon ban in Massachusetts was associated with 3.4% higher generic use for 23 drugs compared with New Hampshire. After the limited coupon ban took effect, there was a nonsignificant increase of 0.42% (95% CI, −0.06% to 0.90% P = .08) in the absolute level of generic use in California relative to surrounding states, with no significant change in the trend ( P = .63).ĭrugs without coupons had similar increases in generic use, from 90.2% to 95.6% in California and from 90.8% to 96.9% in surrounding states the coupon ban was associated with a small, nonsignificant decrease of 0.06% (95% CI, −1.14% to 1.03% P = .92) in the absolute level of generic use in California relative to surrounding states, with no significant change in the trend over time ( P = .77).Ī 2017 California law banning use of co-payment coupons for brand-name drugs with direct generic competitors was associated with no significant increase in generic substitution in its first year. Prior to the California coupon ban, the level of generic use was 0.94% lower in California than in surrounding states (95% CI, 0.57%-1.31% P < .001). We identified 15 drugs with coupons and 26 drugs without coupons, accounting for a combined 1.26 million claims in California and surrounding states ( Figure 1).Īmong drugs with coupons, generic use increased from January 2017 to December 2018 from 91.3% to 96.3% in California and from 92.1% to 96.9% in surrounding states ( Figure 2). ![]() We obtained approval from the Mass General Brigham institutional review board and analyzed data using the Aetion Evidence Platform ( Aetion Inc) and SAS software, version 9.4 (SAS Institute Inc). We fit segmented linear regression time-series models assuming first-order autocorrelation (eAppendix in the Supplement) and identified significant changes using a 2-sided P<.05. We measured the monthly percentage of generic claims in California compared with surrounding states for drugs with coupons (primary cohort) and those without coupons (control cohort). Archived manufacturer websites and an online drug coupon database were searched to identify whether the manufacturer for each drug offered a co-payment coupon after generic competition began and through December 2018.įrom a large national health insurance claims database (IBM MarketScan), we identified commercially insured patients younger than 65 years in California and other Western states (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming) who filled prescriptions for these drugs in 2017-2018. We identified brand-name drugs facing first-time generic competition from 2014 through October 2016, excluding clinician-administered drugs. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]() Challenges in Clinical Electrocardiography. ![]()
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