US Pharm. 2021;46(10):21-23.
ABSTRACT: According to recent data, approximately 49% of individuals in the United States use at least one prescription medication monthly, making the affordability of prescription medications a key consideration in patient care. Prescription discount cards, most of which are available at no cost, offer savings to patients who may lack insurance or adequate coverage for their brand or generic medication costs. Numerous programs that provide such cost savings are available, and these cards can be used at many pharmacies across the U.S. The actual savings can vary from pharmacy to pharmacy and card to card. It is important for pharmacists to understand how these discount cards work in order to help patients manage their prescription expenses and to address potential adherence issues related to financial barriers.
According to recent data from the National Health and Nutrition Examination Survey, approximately 49% of persons in the United States use at least one prescription medication monthly.1 This makes the affordability of prescription medications a key consideration in patient care, as substantial increases in the list prices and net prices of branded medications from 2007 to 2018 (159% and 60%, respectively) have been reported.2 Furthermore, the 2019 KFF (Kaiser Family Foundation) Health Tracking Poll determined that one in four adults has difficulty paying for medications, leading to about 19% of individuals not filling their medication prescriptions, 18% substituting OTC products for their medications, and 12% skipping doses or cutting their medications in half so that they last longer.3 Therefore, financial barriers for patients (e.g., lack of insurance, high deductibles, high copayments) must be addressed by healthcare professionals in order to help their patients achieve better medication adherence and adequate disease-state management.4
Over the past few years, there has been increased interest in and use of manufacturer-sponsored programs, pharmacy-specific savings plans, and prescription discount cards to help offset patient out-of-pocket medication expenses. Manufacturer discount programs, also referred to as manufacturer-sponsored prescription coupons, are provided by pharmaceutical companies to encourage the use of specific brand medications. These manufacturer coupons are commonly combined with commercial insurance to lower copayments for a certain period of time. However, patients may not be able to continue using the brand medication after the manufacturer coupon expires and the prescription savings are no longer available.4-6
A number of larger pharmacies across the country have created their own savings plans to make prescription medications more affordable. Unlike manufacturer-sponsored programs, the medications that are offered at lower cost under pharmacy-specific savings plans are generics. For patients with insurance, copayments may or may not be more cost-effective than using such a savings plan. For patients without any prescription coverage, these plans may be quite helpful in ensuring medication management of various disease states.4-6
In certain cases, a patient may require brand or generic medications that are not included in manufacturer-sponsored programs or pharmacy-specific savings plans. Prescription discount cards provide savings for brand and generic medications, and these cards are sometimes more cost-effective than the aforementioned cost-savings options or in situations where the patient lacks insurance coverage for prescriptions or has a high deductible or copayment when using an insurance plan. Prescription discount cards may be also used for pet medications, for which many pet owners must pay out of pocket regardless of pet insurance coverage.4-6
How Prescription Cards Work
Most prescription discount cards are available at no cost and are convenient to acquire via the Internet or a mobile application (app). The card is presented to participating pharmacies in the same manner as insurance cards for processing. It is important to note that these discount cards cannot be combined with prescription coverage; therefore, any medication costs would not be applied toward insurance deductibles or out-of-pocket maximums.4,6
The process by which prescription discount cards work is generally the same for all cards and involves three main entities: the pharmacy benefits manager (PBM), or administrator; the pharmacy; and the marketing company. The PBM is the company that creates the discount program and negotiates discount prices with participating pharmacies. The PBM then works with marketing companies to promote and advertise the discount card.6,7 The participating pharmacies honor different discounts on various prescription medications. Typically, larger pharmacies choose to participate in prescription discount plans as a means of building patient loyalty, increasing the number of transactions, and boosting overall revenue from items other than prescription medications despite the potential reduction in pharmacy revenues from certain costs (e.g., negotiated discount price, pharmacy-transaction fees, PBM fees, marketing fees).5,7
Considerations for Prescription Discount Cards
Numerous prescription discount cards are available for use at tens of thousands of pharmacies nationwide (TABLE 1). These card programs offer discounts of up to 85% on prescription medications (brand and generic), but the actual savings can vary from pharmacy to pharmacy and card to card. The cards may be printed out from the program’s website or, in the case of some discount cards, presented to the participating pharmacy via a mobile app. Certain prescription discount cards also offer conveniences such as free home delivery, whereas others provide a more extensive network of participating pharmacies.5-7
It is important for both pharmacists and patients to understand the potential benefits and risks of using prescription discount cards. The most obvious benefit is the cost savings to the patient from various discount cards, which may be obtained at no cost. Patients can compare medication prices offered by the various free prescription discount cards either online or via mobile apps to determine the most cost-effective option. Additionally, patients can compare these savings with those offered by manufacturer-sponsored programs (for brand medications) and by pharmacy-specific savings plans (for generic medications).
It should be noted that because the costs of prescription medications fluctuate, patients may be given varying discounts on different days. Therefore, patients should be urged to check discount prices immediately before they go to the pharmacy to fill their prescriptions. Pharmacists must also remember that claims that are processed using prescription discount cards are cash claims with little to no transaction transparency because insurance cannot be combined with these cards. Therefore, the ability to measure and ensure adherence may be limited, creating a potential barrier to comprehensive care.6,7
Prescription discount cards offer brand and generic medication savings for patients who may lack insurance, have inadequate prescription coverage, and/or have pets that take medications. It is important to remember that these cards are not a type of insurance, but rather are an option for individuals who may otherwise be unable to pay for their medications. Pharmacists should be familiar with how discount cards and other types of prescription savings options work in order to advocate for the most affordable patient-specific medications. In many cases, prescription discount cards may be a patient’s best option; however, the potential benefits and risks should be considered on an individual basis.
1. National Center for Health Statistics. Therapeutic drug use. www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm. Accessed August 1, 2021.
2. Hernandez I, San-Juan-Rodriguez A, Good CB, Gellad WF. Changes in list prices, net prices, and discounts for branded drugs in the US, 2007-2018. JAMA. 2020;323(9):854-862.
3. Kirzinger A, Lopes L, Wu B, Brodie M. KFF health tracking poll—February 2019: prescription drugs. Kaiser Family Foundation. www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-february-2019-prescription-drugs/. Accessed August 1, 2021.
4. Moriates C. Addressing affordability—cost of care’s clear focus. https://costsofcare.org/addressing-affordability-costs-of-cares-clear-focus/. Accessed August 1, 2021.
5. Dr Christina Polomoff discusses the complex world of medication discount cards. Am J Manag Care. www.ajmc.com/view/dr-christina-polomoff-discusses-the-complex-world-of-medication-discount-cards. Accessed August 1, 2021.
6. Feke T. Best prescription discount cards. www.verywellhealth.com/best-prescription-discount-cards-4801786. Accessed August 1, 2021.
7. Sagall RJ. Drug discount cards—lifting the veil of secrecy. https://costsofcare.org/drug-discount-cards-liftin-the-veil-of-secrecy/. Accessed August 1, 2021.
8. Doherty K. GoodRx to buy Perelman’s RXSaver business for $50 million. www.bloomberg.com/news/articles/2021-05-13/goodrx-said-to-buy-perelman-s-rxsaver-business-for-50-million. Accessed August 1, 2021.
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