Abstract 13487: Amazon Pharmacy's RxPass to Achieve Modest Out-of-Pocket Savings on Generic Prescription Medications

Introduction: In January 2023, Amazon introduced a $5/month medication subscription service called RxPass for its Amazon Prime members. The service covers over 80 generic medications, including 12 for cardiovascular conditions. We evaluated how much US adults could save by using RxPass and determined the characteristics of those most likely to benefit.

Method: In this observational study of adults aged 18-64 years who were prescribed at least one medication in the RxPass formulary, we used the 2019 Medical Expenditure Panel Survey (MEPS) to estimate the number of adults who spent more than the $199 annual cost of Amazon Prime & RxPass on eligible medications. A multivariable logistic regression model was then fitted to assess individual characteristics associated with saving under RxPass.

Results: If the weighted study population of 50,845,777 adults (standard error [SE] ±1,711,996) obtained eligible medications from Amazon’s RxPass, only 5.1% (2,602,310 [±119,628]) would achieve savings. The estimated average out-of-pocket spending on eligible medications for those who would save by using RxPass was $354 (SE ±$16.1) per year. The estimated average out-of-pocket savings from using RxPass was $155 (SE ±$16.1) per year (Figure), resulting in a total savings of $404,482,986 (SE ±$49,831,316) per year.

Lack of insurance coverage and being prescribed a greater number of RxPass-eligible medications were each associated with a higher likelihood of achieving savings under RxPass. Being from a racial or ethnic minority background was associated with a lower likelihood of savings.

Conclusion: These findings suggest that Amazon RxPass will achieve only modest out-of-pocket savings for a limited number of working-age adults. The observed racial and ethnic disparities reflect well-documented barriers in medication access. Adjustment of the RxPass pricing structure is necessary for the program to improve access and adherence to common generic medications.