Out-of-Pocket Prescription Drug Costs for Adults with Cardiovascular Risk Factors Under Amazon's Direct-to-Consumer Pharmacy Service.

BACKGROUND: US adults often overpay for generic prescription medications, which can lead to medication nonadherence that negatively impacts cardiovascular outcomes. As a result, new direct-to-consumer online medication services are growing in popularity nationwide. Amazon recently launched a $5/month direct-to-consumer medication subscription service (Amazon RxPass), but it is unclear how many US adults could save on out-of-pocket drug costs by using this new service.

OBJECTIVES: To estimate out-of-pocket savings on generic prescription medications achievable through Amazon's new direct-to-consumer subscription medication service for adults with cardiovascular risk factors and/or conditions.

METHODS: Cross-sectional study of adults 18-64 years in the 2019 Medical Expenditure Panel Survey.

RESULTS: Of the 25,280,517 (SE ±934,809) adults aged 18-64 years with cardiovascular risk factors or conditions who were prescribed at least one medication available in the Amazon RxPass formulary, only 6.4% (1,624,587 [SE±68,571]) would achieve savings. Among those achieving savings, the estimated average out-of-pocket savings would be $140 (SE ±$15.8) per person per year, amounting to a total savings of $228,093,570 (SE ±$26,117,241). In multivariable regression models, lack of insurance coverage (adjusted odds ratio [OR] 3.5, 95% CI 1.9 to 6.5) and being prescribed a greater number of RxPass-eligible medications (2-3 medications versus 1 medication: OR 5.6, 95% CI 3.0 to 10.3; 4+ medications: OR 21.8, 95% CI 10.7 to 44.3) were each associated with a higher likelihood of achieving out-of-pocket savings from RxPass.

CONCLUSIONS: Changes to the pricing structure of Amazon's direct-to-consumer medication service are needed to expand out-of-pocket savings on generic medications to a larger segment of the working-age adults with cardiovascular risk factors and/or diseases.