Insurance or Discount Card for Prescriptions?

Should I Use My Insurance or an Rx Discount Card for This Prescription?

It is once again that time to go to the pharmacy and pick up your prescription.  This may be a recurring prescription that you pay for each month as a maintenance medication, or it could be because you came down with that irritating cold/cough/sinus infection that you get once a year, guaranteed every February – like me, and you just need to pick up some antibiotics and congestion relief meds.

You have two questions to ask yourself when you pull up to that drive-thru window or walk up to the checkout counter:

1. Do I want to use a discount card on my medications and not pay full price?  Or,
2. Should I use my insurance and make sure the co-pay counts towards my health plan?

It is always best to compare costs in advance

Even before you drop your prescription off at the pharmacy, hop on your phone or computer and go to: https://www.goodrx.com/.  This discount program is accepted at most major pharmacies, including CVS, Walgreens, Walmart, Costco, Safeway, Kroger, and Rite Aid.  GoodRx is a free price comparison tool that helps you find the lowest cost at pharmacies near you for both brand name and generic drugs.  It is highly likely that the cost of your drug is going to be much cheaper when using a discount coupon, and it may be more affordable for you than filing the drug with your insurance.

Should you decide to use the discount coupon?

If you decide to go the route of using an Rx discount card or a manufacturer’s coupon, it is important to keep in mind that the amount you pay will NOT be applied toward your medical deductible or out-of-pocket maximum.  You may want to reach out to your health insurance company to see if you are able to submit receipts for GoodRx prescription purchases.  Some health plans may allow you to potentially get reimbursement or credit toward your deductible or out-of-pocket limits.  One other thing to note is that these discount coupons are not eligible for people enrolled on Medicare Part D for their prescriptions.  They cannot be combined with Medicare, unfortunately.

Should you make it count towards your deductible?

Depending on what your year is looking like, it may benefit you to pay the pharmacy copay and file that pharmacy claim through your insurance.  If you are taking multiple medications consistently or plan to have any medical procedures, surgeries, scans, lab work, etc. throughout the year, the more copays you spend at the pharmacy, the sooner you will meet your minimum requirements of spending toward your deductible or out-of-pocket maximum.

At the end of the day, the decision is up to you depending on your own unique situation.

If you are just filling a couple of prescriptions once a year to treat that stubborn annual sinus infection, it is probably more cost-effective to use a an Rx discount card or manufacturer’s coupon to pay less for your medication.  But, if you know you need to reach your deductible or out-of-pocket maximum sooner in the year because you have an upcoming surgery, it would behoove you to go ahead and pay the pharmacy copay price for your prescriptions so that amount counts toward your insurance spending and you receive credit for it.  If you end up having a “catastrophic” year, where a major event happens and you end up paying your full deductible or out-of-pocket maximum all at once anyway, then it really doesn’t matter which route you go.

Tips from our friends at EHIM Rx

There are several ways you can enhance the way your pharmacy plan works. The approach may differ if you are a consumer, or you are in charge of making decisions for your company’s health plan.

Here are our 5 “Quick and Dirty” ways to improve your prescription experience:

1. Members should inquire with their pharmacy benefit manager (PBM) listed on their insurance card to determine if they get the best price regardless of the discount offered. IE: If a pharmacy chain is advertising a $4 generic, and they have a $10 generic copay, will they get the lower cost?
2. Plan sponsors should insist their RX copays are NOT on their ID cards to make sure members always get the best deals!
3. Members should always ask doctors for lower-cost alternatives. When these are not available, ask if their medication is available for a free sample – especially if it’s a newer medication!
4. Be careful with coupons! Sometimes Coupons are selling members much more expensive medications in disguise – be a consumer to your overall health plan and look into the actual cost of medications – not only what your out of pocket impact is. This saves the entire health plan in the long run!
5. Many pharmacy benefit plans include coverage on Over the Counter versions of prescription medications – often at no cost to the member!

At Generous Benefits, we offer plans that already reward the member with a cost lower than the pharmacy drug copay. We believe it is important to reward good behavior any time it will help lower costs for your company’s health plan.