There are many different prescription medications available for you and your healthcare providers to choose from, however, some choices can be more expensive than others. New therapies tend to be more expensive than standard of therapy choices, and this can be from a number of reasons. It is already confusing choosing an insurance plan, but understanding how prices/costs are passed down to you, the patient, is even more confusing. There are some interesting proposals being looked into by our government in regards to pharmacy benefit management transparency, but these are ongoing and will take time to become approved.
One way is through manufacturer copay cards. What is a copay card? A copay card is a way for a manufacturer to increase their market share, ie obtain more patients utilizing their medication. A manufacturer can determine how much they are willing to provide as payment towards your medication, and this amount can be applied towards your copay from your insurance. More simply put, they can reduce the amount of your out of pocket costs when purchasing their medication, and sometimes even reduce it to $0!!!
Of course, as with any sort of rebate/coupon, there are restrictions and limits of use. Federal resctrictions include:
In Massachusetts, copay cards are only eligible to be used on Brand name medications which DO NOT have an A-rated generic. This means, only medications that have no generic available are eligible to be covered by these cards in Massachusetts. In addition to this, absent of 2017 regulatory updates, manufacturer copay cards are set to expire on July 1, 2017.
Until then, these copay cards can be excellent ways to lower your out of pocket costs. Some of these cards work even if your insurance does not cover the medication!* And, some work for refills too.
A free trial is slightly different from a copay card in that it can work regardless of insurance coverage. Their limitations are usually set to ONE use per 365 days. They can be beneficial to patients trying out a new medication. One thing to consider is coverage after the trial. If the medication is not covered through your insurance after the trial, you may be left having to pay the full amount. So before starting, it might be beneficial to check your formulary with your insurance company to see if you will have continued coverage on the medication. Manufacturer free trials are not submitted to your insurance company, so they are not applied to any deductible you may owe or any of your own medical expenses for the year.
Patient Assistance Programs are developed and provided by manufacturers to ensure that medication is available to those in need. Usually these programs require tax returns and other documentation to assess eligibility. Patients who utilize programs like this are usually limited to receiving the medication direct from the manufacturer via mail rather than from their pharmacy of choice, but for many this can be a crucial program to continuing a medication.
Some of these options can be obtained at your healthcare provider's office, and if not, can be obtained on the manufacturer's website. I would caution any individual who is looking for "Discount Prescription Cards" that they limit as much of their own personal information as possible. For the insured, "Discount Prescription Cards" provide limited if any benefit, and the insurer usually provides the most cost effective option. Be careful when providing ANY of your personal information in any format, whether via phone, e-mail, or internet website.
One place that I have found to be relatively helpful is this new site called OneRx.com. They have a unique database which contains information on most available manufacturer coupons, rebates, trials, and assistance programs. Their tool the "Coupon Lookup Tool" is a really nice and easy to use search which can help you find the correct link to the manufacturer's website. You can navigate to this site here: OneRx.com
Finding any ways to save can truly add up, but I issue this one cautionary statement: Be VERY careful with your personal information. I always tell anyone in their search to limit their search as much as possible to the ACTUAL manufacturer's website. There can be many counterfeit sites, places that want to collect your information, and these can be incognito as a site to help you save money. Be cautious, and if you have questions, ask. We are always here to help and can look it over for you before you proceed.
*They can reduce the full cost of the medication even if your insurance does not provide coverage. This is most beneficial in instances where a patient has tried alternatives and wants to try a particular medicine, but it may be just out of reach, and a copay card could bring it into reach.
By: Jeremy KW Spiewak, PharmD, RPh
Original Published: September 2016
Revised: September 2016