Grassley, Hassan Call for Review of Big Pharma Tactic to Raise Drug Costs

Grassley, Hassan Call for Review of Big Pharma Tactic to Raise Drug Costs

BUTLER COUNTY, IOWA - U.S. Sens. Chuck Grassley (R-Iowa) and Maggie Hassan (D-N.H.) are calling on the Government Accountability Office (GAO) to investigate pharmaceutical companies use of "coupons" as a tactic used to steer patients away from lower-cost generics. The senators sent a letter requesting GAO investigate the ways pharmaceutical companies use drug coupons to lure in patients with lower upfront costs, then discontinue those coupons with little to no notice, which leaves people with higher bills at the pharmacy counter. Over time, this can keep drug prices high, create unpredictable out-of-pocket costs and raise insurance premiums for everyone.

"Drug companies are often able to keep their drug prices outrageously high by setting their own list price, and then offering copay coupons in order to help some patients afford those high prices. Companies also use drug coupons to increase drug sales for a particular brand-name drug and to steer patients away from lower-cost generics. In fact, pharmaceutical companies earn as much as $4 more in drug sales for every $1 that they spend on prescription drug coupons," the senators wrote.

"While these coupons often lower or eliminate the patient's copays in the short-term, in the long-term they could lead to the patient unnecessarily paying more for the brand-name drug. Brand-name drug coupons can also lead to uncertainty about a patient's out-of-pocket costs from month-to-month, since pharmaceutical companies can change their coupon programs and patient eligibility rules for those programs at any time. We are concerned that these coupons can enable drug manufacturers and pharmacy benefit managers to maintain high list prices and drive up costs for all patients through higher insurance premiums," they continued.

The senators also question GAO about the adoption of real-time benefit tools (RTBT) in the commercial health insurance market. Grassley has previously asked the Centers for Medicare and Medicaid Services (CMS) about the adoption of RTBTs in the Medicare Part D market following the passage of the Consolidated Appropriations Act of 2021. That law required Medicare Part D plans to increase the use of electronic RTBTs to shine more light on patient prescription costs. Grassley's bipartisan 2019 Prescription Drug Pricing Reduction Act included a provision to improve the use of RTBTs in Part D.

Grassley has long championed efforts to reduce the cost of prescription drugs. In recent years, three pieces of legislation authored and coauthored by Grassley have been signed into law, saving taxpayers billions to combat anticompetitive practices and stop drug makers from reaping profits at the expense of taxpayers and consumers. Learn more about Grassley's persistent efforts to lower prescription drug costs HERE.

Read Grassley and Hassan's full letter HERE and below.

April 21, 2026

The Honorable Orice Williams Brown

Acting Comptroller General of the United States

U.S. Government Accountability Office

441 G Street NW

Washington DC, 20548

Dear Acting Comptroller General Brown,

We write to request that the Government Accountability Office (GAO) conduct a review of manufacturer prescription drug coupons and their impact on drug utilization and the commercial insurance market.

Pharmaceutical companies often offer coupons to privately insured patients in order to provide discounts on brand-name drugs even when lower-cost generic alternatives are available. While these coupons often lower or eliminate the patient's copays in the short-term, in the long-term they could lead to the patient unnecessarily paying more for the brand-name drug. Brand-name drug coupons can also lead to uncertainty about a patient's out-of-pocket costs from month-to-month, since pharmaceutical companies can change their coupon programs and patient eligibility rules for those programs at any time. We are concerned that these coupons can enable drug manufacturers and pharmacy benefit managers to maintain high list prices and drive up costs for all patients through higher insurance premiums.

Drug companies are often able to keep their drug prices outrageously high by setting their own list prices, and then offering copay coupons in order to help some patients afford those high prices. Companies also use drug coupons to increase drug sales for a particular brand-name drug and to steer patients away from lower-cost generics. In fact, pharmaceutical companies earn as much as $4 more in drug sales for every $1 that they spend on prescription drug coupons. Manufacturers are banned from offering these coupons to patients who are covered by Medicare and Medicaid under anti-kickback laws, due to the fact that the coupons encourage doctors to prescribe more expensive drugs under public payers when cheaper versions are available.

One reason why patients may use manufacturer prescription drug coupons is because it is difficult for the patient to determine which prescription drug option will be most affordable. Many patients do not know what they are expected to pay for a drug when they go to the pharmacy counter. One way that patients can get accurate and clinically appropriate information about their most affordable medication option is through an online real-time benefit tool, which shows providers and pharmacists real-time drug cost information, coverage information, and alternative medication options within electronic health record systems. The Consolidated Appropriations Act of 2021 required Medicare Part D plans to increase the use of these real-time benefit tools, and we seek information on how these tools are being used in private insurance plans as well as Medicare Part D.

To better understand the impact of prescription drug coupons and the availability of real-time benefit tools in the commercial insurance market, we request that GAO provide responses to the following questions:

1. Describe, to the extent that reliable data are available, the availability and characteristics of manufacturer prescription drug coupons for the highest expenditure prescription drugs in the commercial market. Examples of such characteristics could include whether the drug is single source or has generic equivalent or a biosimilar, whether the drug has a therapeutic substitute, the dollar value of the coupon, who is eligible to use the coupon, and the terms and conditions for the coupon.
2. Describe, based on evidence from published studies, how manufacturer prescription drug coupons can affect the use of a drug.
3. Describe how plan sponsors in the commercial market have responded to the use of manufacturer prescription drug coupons for the highest expenditure prescription drugs, including how coupons are considered in benefit design decisions and patient premium and cost-sharing calculations.
4. Describe the extent to which prescribers, patients, and pharmacists are able to access to electronic real-time benefit tools in the commercial health insurance market.

Thank you for your prompt attention to this request.

Sincerely,

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