Blog – Page 4 – TheFrugalPharmacist

With the ever rising cost of prescription drugs for Americans we can't help but search for ways to lower our out of pocket costs. One of the best methods to lower costs on generic medications is to use prescription savings cards. But what if you have insurance? Can you still use a prescription discount card with insurance? If you have insurance you can still use a prescription discount card to lower the out of pockets costs for your medications. The only caveat is that you cannot combine a discount card AND your insurance together. The good news is you have a choice to use the lowest cost option. However, manufacturer copay savings cards for brand name medications CAN be combined with most insurances. Why discount cards and insurance cannot be combined? The process a pharmacy uses to determine your prescription copay is called adjudication. In simple terms, the pharmacy sends your prescription information, including the asking price (cash price), electronically to the insurance companies computer system. The insurance cross references the information with your plan benefits and returns the negotiated price broken down into the amount the plan will pay the pharmacy and your copay. image courtesy of https://www.slideshare.net/Mike97/the-medicare-part-d-benefit-payment The same process is used to process a claim using a prescription discount card. The pharmacy send the full price of the medication to the discount card processor and the negotiated price is returned. This price includes several fees as explained in "How prescription discount cards work". Since the pharmacy is unable to perform what is called a coordination of benefits with both the insurance plan and the discount card they can't be combined. Likewise, a prescription discount card CANNOT be combined with a manufacturer copay savings card either. The advantages of using a prescription discount card The major advantages of pharmacy discount cards over standard prescription insurance coverage are: Rx discount cards don’t require you to meet a deductibleYou don’t have monthly paycheck deductions for premiumsYou aren’t limited by certain time frames to refill your medicationsThe cards are freePrescription discount cards never expireMost are accepted at every pharmacy nationwide (no network restrictions)No prior authorizations or other limitationsMany discount card companies have convenient smartphone apps you can use to shop around and find the cheapest price BEFORE you leave the doctors office When is it smart use a prescription discount card? When the discount card is cheaper The most obvious time to use a prescription discount card instead of your insurance is when the price is lower. The unfortunate thing is that there really isn't a convenient way to find out which option will be cheaper until you get to the pharmacy and wait for the technician to enter your prescription and adjudicate the claim through each option to find out the prices. Pricing the medication through the discount card via a mobile app or website while at the doctors office can provide some insight if you already know your insurance copay ahead of time. Deductibles or the "Donut Hole" When you are in the deductible phase of your insurance plan structure you are paying the full cost of your medication. If you are a senior in the medicare part D coverage gap, fondly called the "Donut Hole", you are similarly paying a much higher percentage of your medication costs. I encourage you to evaluate whether your insurance copay or the price using a prescription discount card is the lower cost alternative if you are encountering one of the above scenarios. When the medication is not covered by your insurance Insurance companies compile a list of medications that they negotiated prices on called a formulary. Many times these formularies exclude commonly prescribed medications for a number of reasons such as: The medication has an equivalent available OTC. Examples include Prilosec, Nexium, Zantac, Flonase, Claritin, Zyrtec, or VitaminsThe medication is considered a "lifestyle drug". Examples include Viagra, Cialis, Phentermine, Hydroquinone cream, Latisse, etcOther exclusions such as cough syrups containing codeine, tessalon (benzonatate), Phenazopyridine, etc Prior Authorizations or quantity limits Insurance companies also put limitations or special requirements that must be met before they will cover some medications. This quite often causes a long delay while the prescriber completes the paperwork and the insurance representative reviews it for approval or denial. This process is called a prior authorization. Prior authorizations are most commonly seen with medications like: ADHD medications like Adderall, Vyvanse, Ritalin, or ConcertaTestosterone hormone replacement therapyTopical acne treatment medicationsVery expensive Brand Only medicationsMost recently, opioid pain medications due to the opioid epidemic sweeping across the country. Just remember, you always have the right to pay cash using a prescription discount card instead of your insurance. You don't have to wait and jump through the hoops of fire and do a little dance. Although, some pharmacies do have policies against accepting discount cards on controlled substances. You lost your medication or it was stolen There may be times you lose your medication or it gets stolen. Most times the pharmacy technician can call your insurance company and inquire if there are any overrides available for your specific situation. If your insurance company does not authorize an override then using a pharmacy savings cards is your best option. Expert Tip Only purchase the amount of medication you need until the next earliest date that your prescription insurance will authorize payment for your prescription. Ask the pharmacy technician for help to figure out how much you may need. The pharmacy is not contracted with your insurance Insurance companies, and sometimes plan sponsors (employer groups), restrict patients to using only certain pharmacies. The justification is to reduce costs by driving a higher number of patients to a pharmacy chain which agrees to lower negotiated rates in exchange for more customer traffic. Although, CVS and Walgreens seem to be on every corner in larger metropolitan areas, they aren't found in many smaller communities. Since they are the major players in this preferred (narrow) network movement, patients in rural areas frequently get caught up in the mess this causes. Pharmacy discount cards do not participate in this choice limiting fiasco so you can still get your prescriptions from the pharmacy that YOU CHOOSE. Can you combine multiple pharmacy discount cards? Although combining multiple prescription discount cards would be awesome, you can only use one discount card per prescription. It is important to remember that obtaining a discount card does not mean you have insurance. You can’t use your discount card for other healthcare expenses (i.e., medical, dental, vision, etc.). However, Singlecare does offer discounted medical, dental, and vision in addition to their rx discount card since they are privately-owned and don’t have any conflict of interest with health insurance companies. Manufacturer Copay Savings cards Manufacturer sponsored copay savings cards are distinctly different from prescription discount cards. Brand name drugs typically have much higher copays than generic medications so the manufacturers create these programs to help make their medications more affordable. Drug makers do not do this out of generosity however. The motivation for helping reduce the out of pocket costs to you and me is to increase the number of people taking their medications and improving their sales and profits overall. How do manufacturer copay savings cards work? Contrary to prescription discount cards, pharmacies are allowed to perform coordination of benefits with copay savings cards. During the adjudication process, after the primary insurance returns your copay, the pharmacy then sends the copay amount to the manufacturer savings card processor which then returns the payment to the pharmacy and the promotional copay as determined by the terms of the savings card. And just like that, you save money and the drug company sells more of its product. Have a government sponsored insurance? If yes, then you are out of luck. The government explicitly prevents drug companies from promoting drugs through copay savings cards to medicare, medicaid, ChampVA, and other government sponsored prescription insurance program beneficiaries. Where do you get a manufacturer copay savings card for your medication? The easiest place to get a copay savings card is the manufacturers product website. Just do a google search for "Brand Drug Name copay card", where "Brand Drug Name" is the name of your medication. Google will return the registration page for your desired drug savings card as the first result. Drug sales reps often leave copay cards at your prescriber's office as well. If you have a high copay ask the nurse, medical assistant, or prescriber if they have any on hand to give you. Sometimes they even have free trial offers or, better yet, drug samples they can send you home with.