As members and plan sponsors 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.
As a benefit advisor, your clients may ask you, “Should I encourage my members to use discount programs instead of their pharmacy benefit?” To know if a discount drug program is a good resource for your clients, first you need 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. They can be applied to brand-name and generic medications, but 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 with prescriptions not covered by a pharmacy benefit formulary. As members adopt a consumer mindset and search for the lowest-cost prescription available, some with pharmacy coverage also look to use these discount drug programs outside the pharmacy benefit.Plan sponsors wanting to drive down pharmacy benefit spending may consider encouraging their members to use discount programs – but they may not know integrated point-of-sale discount programs may provide a better fit for the member and the pharmacy plan.
Will a discount drug program work when a member has pharmacy insurance coverage?
Historically, discount cards and prescription coupons haven’t worked with the pharmacy benefit, meaning the pharmacy benefit manager’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, as of January 2024, the top three PBMs will all have their own point-of-sale discount program seamlessly integrated with the pharmacy benefit. CVS’s Cost Saver™ and Express Scripts’ Price AssureSM both cover non-specialty generic drugs via GoodRx®, and Optum Rx Price Edge covers select non-specialty generic drugs and some over-the-counter drugs, supplements, and other non-covered products.
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 program offered by your client’s PBM offers the benefit of cost savings of a traditional card or coupon program, with the clinical oversight and benefit value associated with your client’s pharmacy plan.Program details vary between PBMs, and some are available on an opt-in or opt-out basis. You’ll need to talk with your pharmacy benefits vendor for specifics about what will be available to your clients as part of their integrated point-of-sale discount program. Plan sponsors covered by those programs should inform their members that, starting in January, their current plan ID card carries essentially all the benefits of a traditional discount plan, and that no other cards, coupons, or price comparisons are needed to save on the price of their prescription.