For many Americans, it started with a mysterious envelope in their mailbox.
Inside was a thin, white-and-yellow card that said “GoodRx” and looked a bit like a health insurance card, even though it wasn’t. Perhaps the recipient threw it out; perhaps they were intrigued. Regardless of the recipient’s initial reaction, GoodRx soon became impossible to ignore.
Cards appeared at doctors’ offices, at pharmacies, and in television ads. To the uninitiated, this intense marketing may have seemed insidious – but there was nothing to fear.
GoodRx is just one of many prescription discount cards (also called copay or coupon cards) which helps patients afford their medications; others include US Pharmacy Card, Discount Drug Network, ScriptRelief, SingleCare, and a plethora of drug-specific cards.
While their long-term impact on the healthcare industry cannot be certain, the positive impact of discount cards on patients is impossible to ignore. Let’s clear away the mystery around this popular patient tool.
1. How do discount cards work and what are the differences?
First of all, prescription discount cards are not insurance. While they may interact with drug coverage, this depends on their source. They can come from either independent benefit companies – like GoodRx, US Pharmacy Card, and the rest – or drug manufacturers.
Independent discount cards are used instead of insurance.
Consumers sign up online, then show the physical or digital card to their pharmacist. The pharmacy processes the prescription using the discount card information rather than the consumer’s insurance information, and the consumer pays a reduced cash price instead of paying their usual copay.1 If the cash price is less than the consumer’s copay, then it’s a good deal.
It’s important to understand that the cash payment does not contribute to a consumer’s deductible, though.
The pharmacy then pays a transaction fee; that’s how the discount card companies benefit. Pharmacies are willing to do this because providing a lower price means consumers are more likely to return to that pharmacy and fill their prescriptions rather than abandon them.2
Manufacturer discount cards can be used with insurance.
Consumers can find them on the manufacturer’s website, or their doctor will offer a card at the point of prescribing. When the card is used at the pharmacy, the consumer will pay a reduced copay or nothing at all. The manufacturer covers the balance of the copay but the claim still goes through insurance, meaning that the consumer’s pharmacy benefit manager is paying the balance of the drug price.3
2. What are the benefits?
Regardless of how they function, both types of discount cards are powerful tools for consumers on plans with high deductibles, high copays, or very limited drug formularies. Without a discount, the cost of their prescriptions could keep these consumers from even starting therapy.
Not to mention, the savings really do add up. Imagine you’re a household with numerous family members on multiple medications and your family deductible is nearly impossible to meet. Utilizing a card like PDR for 10 prescriptions, you’ll see an average discount of $20, and the total savings would be $200.8 That’s money back in your pocket to allocate toward whatever you choose.
3. Do your own research
Not every card is equally useful and reliable. It’s always best to do one’s own research rather than using whichever card seems convenient.
Consumers should investigate how and when the card can be used. Independent discount cards can only be used at in-network pharmacies, and even then, they may provide better discounts at one pharmacy over another. Some charge a membership fee and should be avoided altogether. Some require consumers to print out a coupon or use a mobile app.4
Many cards cannot be used by Medicaid or Medicare members – though Medicare-approved drug discount cards, or MADDCs, do exist.5 Generally, manufacturer cards can only be used by consumers with commercial insurance.6 In addition, some states have legislated how manufacturer cards can be used. In 2017 California banned the use of manufacturer coupon cards for any drugs that have a generic equivalent.7
cards are an impactful part of a complex and nuanced healthcare landscape. Stay
tuned as we continue the conversation on how to best navigate these useful
tools and provide insights on how to find the most affordable paths toward