As members and clients look for ways to drive down the cost of prescription drugs, many are drawn to discount programs that offer cards and coupons. These programs advertise lower prices but don’t always utilize the member’s pharmacy benefit to fill their prescription. As members get savvier about drug prices and their pharmacy options, these discount drug programs are drawing more attention.
Clients may ask, “Should I encourage my members to use discount programs instead of their pharmacy benefit?” To answer this question it’s important to understand how these programs interact with existing pharmacy benefits.
How do discount drug programs work?
Prescription discount cards and coupons are available online and in the mail. The companies behind these programs negotiate bulk purchasing prices with drug manufacturers, compare prices at multiple pharmacies, and receive payments from pharmacies whenever their cards are used to purchase a prescription. The pricing and specific drugs impacted vary by programming.
Accessing these cards and coupons is free, and these programs provide a safety net for those without insurance or whose insurance does not cover their prescriptions. However, many members with pharmacy coverage nonetheless look to use these discount drug programs outside their benefits in pursuit of the lowest prescription costs possible. Is this approach effective?.
Will a discount drug program work when a member already has pharmacy insurance coverage?
Historically, discount cards and prescription coupons aren’t incorporated into the pharmacy benefit, meaning the PBM’s system didn’t log these fills and the prescriptions didn’t have the benefit of clinical oversight. Members who use discount programs outside their benefit also don’t contribute to their deductible and out-of-pocket maximum – and the discounted cost wasn’t compared to the member’s cost share under the pharmacy benefit to ensure they really are saving money.
However, some larger PBMs have their own point-of-sale discount program seamlessly integrated with the pharmacy benefit, which covers non-specialty generic drugs and some over-the-counter drugs, supplements, and other non-covered products, depending on the PBM.
These programs allow members to access low prices on commonly prescribed drugs without having to shop around, working within their pharmacy plan with no additional cards or paperwork needed. Because the discount programs are automatically linked to the benefit plan, the clinical oversight remains intact, and the member’s claim applies to their deductible and out-of-pocket maximum like any other prescription. Their cost share is compared to the on-benefit pricing to confirm that money is being saved.
Should you recommend a discount card or coupon program to your clients?
The integrated point-of-sale discount programs offered by the PBMs provide the cost saving benefits of a traditional card or coupon program, with the clinical oversight and benefit value associated with each client’s pharmacy plan.
Program details vary between PBMs, and some are available on an opt-in or opt-out basis. Each pharmacy benefits vendor can share specifics about what it provides as part of its integrated point-of-sale discount program.
