Rx Coupons and other discounts

GoodRx, Trump Rx  and Cash-Pay Discount Programs

 

In some situations, a cash-pay discount card such as GoodRx and Trump Rx   may temporarily cost less than using a person’s Medicare Part D plan. However, there are important tradeoffs.

  • How Do GoodRx, Cost Plus Drugs, and Other Drug Discount Websites Work for Medicare Beneficiaries?  Common Wealth Fund.org  
  • Cash-pay purchases may not count toward Medicare Part D out-of-pocket limits
  • Prices can vary significantly between pharmacies
  • Drug discount companies are not insurance companies
  • Discount pricing may change without notice
  • GoodRx Discount Card:
  • Trump Rx
  • cost plus  drugs.com  Mark Cuban
    • Everyone should have safe, affordable medicines with transparent prices.
      • We started Mark Cuban Cost Plus Drug Company because every American should have access to safe, affordable medicines. If you don’t have insurance or have a high deductible plan, you know that even the most basic medications can cost a fortune. Many people are spending crazy amounts of money each month just to stay healthy. No American should have to suffer—or worse—because they can’t afford basic prescription medications.
  • We do not know who they are. We are not endorsing them.
    • This is simply an example of a commonly advertised prescription discount program that some consumers compare against their Medicare Part D copays.
  • Here’s #MoreAassistance
    • Even if you have high assets & Income Beyond Part D Rx
    • Assistance Programs from the Manufacturer and Government Programs

Manufactures Coupons 

 

  • If one has Part D Rx, the manufacturers cannot help out with coupons.  One might consider dropping Part D or if you have Medicare Advantage Plan, finding one that doesn’t include Part D.
    • We CANNOT advise you to do this. It’s beyond our pay grade and we are mandated to tell you about the penalty if you don’t purchase Part D.  I’m having trouble finding a reliable plain English citation for this.  Scroll down for hints from one of our wholesalers on using coupons and not using your Part D Rx plan.
  • The intention for coupons is to steer patients away from cheaper generic alternatives and toward the brands that they produce. That is to increase demand for their drugs. Experts estimate that brand drug manufacturers are spending between $3 billion and $6 billion annually on coupon programs. Anti-Kick Back and all. HHS Report Mfg safeguards might not prevent coupons for Part D Rx.  Legally, the use of drug co-pay cards and coupons by individuals with government funded health care and prescription drug benefits, such as Medicare and Medicaid, is prohibited by the federal anti-kickback statute.
    • (2) Whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person—
      • (A) to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program, or SSA.gov

Resources, Links, Bibliography

Here’s some hints from our wholesaler…

 

  • Coupons are allowed to be used in Medicare, but it is tricky. When a client uses a coupon, or a GoodRX or even the pharmacies billing costs (which are sometimes cheaper than the plan copay) the drug doesn’t get run through Medicare, it becomes a cash pay situation and it doesn’t go against the Medicare deductibles, donut hole,  etc.   So that is the negative.
  • I have many clients that have purchased drugs directly from the pharmacy to get a lower cost, and some that have used Good RX or even just googled their drugs and bought them online at a cheaper cost.
  • There are certain things that are much cheaper online, Progesterone is a big one that my female clients find cheaper online..
  • So, if the pharmacy will work with the client to help them find the lowest cost, there are alternatives for our Medicare clients. Not all pharmacies will do this however, so it is good to do some research on more expensive drugs to find alternative solutions.

Resources

#Co-Pay Accumulator Programs

When Copay Assistance Backfires on Patients  

If a patient has an insurance plan with an accumulator program, all copays funded by the manufacturer copay savings program will not count towards their deductible and annual maximum out-of-pocket costs. When this patient goes to refill their prescription without the copay savings program, they will be responsible for the full cash price of the drug until they reach their deductible and out-of-pocket annual maximum.

In the absence of accumulator programs, when a patient uses a copay savings program, the portion paid by the manufacturer would contribute to the patient’s deductible. However, copay accumulator programs are designed to keep manufacturer contributions from counting towards a patient’s deductible and annual maximum out-of-pocket costs.

  • CMS allows all Insurance Plans to do this.   Good Rx.com * Actuary Magazine.org *  Policy Med.com *  ThomsonReuters *
  • Los Angeles Times explanation April 2018

  • Court Ruling in favor of Rx companies:  The dispute centers on programs in which drug companies help patients cover their share of the prescription drug costs that they otherwise could not afford.

    In recent years, some insurers have established so-called accumulator adjustment programs, in which they do not count assistance toward patients’ deductibles and out-of-pocket maximums. Such programs effectively capture some of the assistance for insurers instead of patients.  Read More Reuters.com

 

Response from Anthem Blue Cross CA…

Our company does use Rx Co Pay Accumulator Programs. Depending on the policy/plan, some Anthem policies do not allow the amounts you save with using a Mfg Rx coupon to count toward your deductible or out of pocket accumulations. Only your true out of pocket expense will be accumulated. If you have any additional questions feel free to contact our Pharmacy Ingenio RX team at 833-419-0530. 

Blue Shield of CA

This confirms member’s who use manufacturer coupons for prescriptions, will be credited the amounts paid towards their deductible/out-of-pocket.

Oscar

At this time, the only amount that will contribute towards the members deductible and/or out of pocket maximums will be the amount that the member pays.

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email us Steve@SteveShorr.com