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Coupons usually in the form of co-pay assistance programs for specialty pharmaceutical products, particularly injectable drugs such as TNF inhibitors can be worth several thousand dollars per year.

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Unlike the distribution of drug samples to patients, without exception drug coupons require a valid prescription written by a licensed physician and dispensed by a registered pharmacist in order for the offer to be fulfilled. Having a physician and pharmacist involved in the transaction enhances patient safety, unlike the use of drug samples.

This dual layer of professional scrutiny ensures that the drug product has been properly stored, is not expired, is dosed correctly in an age-appropriate fashion, and that the patient's medication history has been checked to avoid drug interactions. Drug samples, on the other hand, are often dispensed by doctor's office staff without the benefit of a prescription. The storage of drug samples is largely unregulated, leading to the possibility of spoilage or pilferage.

Additionally, in case of a recall or other similar event there is a paper trail that simplifies patient notification.

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Critics of prescription drug coupon programs have argued that these programs lead to higher healthcare costs for consumers. Typically, American patients with health insurance pay a percentage of the cost of a prescription drug out of pocket, with insurance companies responsible for the rest of the medication's cost. Insurance companies charge higher copayments for brand-name drugs than for generics in order to encourage patients to choose less expensive alternative medications when they are available.

However, by reducing a patient's copayment, prescription drug coupons also reduce a patient's incentive to choose a less expensive generic medication.

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Solodyn can be taken only once daily, while Minocin must be taken twice daily. Since Solodyn's manufacturer offers a coupon to reduce copays, patients may believe that both drugs cost the same amount. Drug coupon advocates argue that coupon programs enhance medication adherence by reducing or eliminating drug copays.

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As of , the U. Food and Drug Administration FDA was planning a study to see if coupons make patients overlook drug risks and side effects in their effort to save money. This is why all prescription drugs include information reviewed and approved by the U. Food and Drug Administration FDA about how the medication works in the body, its uses and when it should not be used, possible side effects, the recommended dosage, and other facts about the appropriate use of the drug.

Before patients take one of these drugs, they and their prescriber should be aware of the risks, and may need to take certain steps that lessen these risks, in order to ensure they benefit from the treatment. Unions have filed several lawsuits seeking to ban drug coupons, characterizing them as illegal kickbacks. As of June, Three of these lawsuits have been dismissed.

Six more are pending. This ruling is seen as vindication for the Pharmaceutical industry that drug coupons are an acceptable business practice.

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For decades, shoppers have taken advantage of coupons. Now, the coupons are taking advantage of the shoppers. While the coupons look standard, their bar codes can be loaded with a startling amount of data, including identification about the customer, Internet address, Facebook page information and even the search terms the customer used to find the coupon in the first place.

And all that information follows that customer into the mall. Coupons from the Internet are the fastest-growing part of the coupon world — their redemption increased percent to about 50 million coupons in , according to the coupon-processing company Inmar. Using coupons to link Internet behavior with in-store shopping lets retailers figure out which ad slogans or online product promotions work best, how long someone waits between searching and shopping, even what offers a shopper will respond to or ignore.

The coupons can, in some cases, be tracked not just to an anonymous shopper but to an identifiable person: a retailer could know that Amy Smith printed a 15 percent-off coupon after searching for appliance discounts at Ebates. While companies once had a slim dossier on each consumer, they now have databases packed with information. And every time a person goes shopping, visits a Web site or buys something, the database gets another entry.

None of the tracking is visible to consumers. Even if consumers could figure out that RevTrax was creating the coupons, it does not have a privacy policy on its site — RevTrax says that is because it handles data for the retailers and does not directly interact with consumers. Using coupons also lets the retailers get around Google hurdles.

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Google allows its search advertisers to see reports on which keywords are working well as a whole but not on how each person is responding to each slogan. The retailers, however, can get to an individual level by sending different keyword searches to different Web addresses. The distinct Web addresses are invisible to the consumer, who usually sees just a Web page with a simple address at the top of it. This data could be coded onto a coupon. View all New York Times newsletters. RevTrax works as closely with image-rich display ads, with coupons also signaling what ad a person saw and on what site. The companies argue that the coupon strategy gives them direct feedback on how well their marketing is working.

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Once the shopper prints an online coupon or sends it to his cellphone and then goes to a store, the clerk scans it. The bar code information is sent to RevTrax, which, with the ad agency, analyzes it.

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