Buying generic drugs to save on prescription drug costs can result in big savings. But sometimes there are no generics available, or the generics that are available don’t work. In other cases, the medicine that your doctor prescribes isn’t on the insurer’s formulary or may not be approved for you. Unfortunately, just as self-pay patients often get overcharged by hospitals and doctors, the same can happen at a pharmacy, where “list” prices are often inflated well above what insurers pay.
What are the choices for self-pay patients who need to buy name-brand pharmaceuticals? One of the easiest solutions is to get a pharmacy discount card. Just as the name suggests, these cards can allow patients to get name-brand drugs at the same prices as insurance companies do, or at least less than the “list” price.
Dr. Richard Sagall, who blogs at Costs of Care, explains the nitty-gritty behind drug discount cards and how they work:
…Drug discount cards have the potential of helping patients save a lot of money, but you have to understand how they work. It’s important to remember that they all work basically the same way…
First, a company called a “pharmacy benefits manager” (PBM) or an adjudicator sets up a network of participating pharmacies that agree to accept the cards. Then, the PBM negotiates with each pharmacy chain and all the participating local pharmacies to offer a discount on the drugs they dispense. The discount offered is usually a percentage of the cash price of the drug and the percentage may vary from drug to drug.
Next, the PBM finds companies or organizations in which to market their card. These groups, called marketers, may be for-profit companies or non-profit organizations. They may be multilevel marketing organizations and some marketers work with multiple groups.
Dr. Sagall, it should be noted, recommends individuals be wary when obtaining drug discount cards, because he apparently has seen many that fail to deliver on the promised benefits. He offers the following advice when looking for a card:
1. Never pay for a card – There are many good cards that are free. There is no reason to pay for a card since it’s unlikely it would offer a discount any better than a free one.
2. Never register for a card – This is one way marketers get info that they sell. The only reason to give your name and address is if the card is being mailed to you.
4. Helpline – All reputable marketers have a toll-free helpline. Give the line a call and see how responsive they are. Do they have real people answering your questions or just a recording? If you leave a message do they call you back?
5. Shop around – Try different cards to see which offers you the best discount. Ask your pharmacist which has the best prices.
6. Consider who is making money – All things being equal, using a card offered by a non-profit is best. Any money they make is going to further their cause while the money earned by a for-profit is just going into someone’s pocket.
I’m not sure I necessarily agree with everything he writes, particularly points #1 and #6, but his advice is certainly worth considering. A couple of reasons why a card you pay for might be worth the money include a wider network of pharmacies that accept it, a wider list of medications that are covered under the discount plan, and other add-on features that drug discount card marketers might add that would be of value.
Still, as with everything else, self-pay patients should carefully weigh the costs and benefits of whatever card, free or purchased, they might chose. Dr. Sagall is certainly correct that there is no shortage of free discount cards available, and the same can be said for cards that are for sale. The list of free discount drug cards includes Your Rx Saving Card, Rx Relief Card, RxSavingsPlus, and SuperRxCard. Dr. Sagall also runs a nonprofit that offers its own free drug discount card, NeedyMeds.
Several chain pharmacies also offer their own drug discount cards, including CVS, Walgreen’s, and Rite Aid. Both CVS and Walgreen’s charge annual fees for their cards ($15 and $20, respectively), while Rite Aid’s appears to be free. But those relatively modest annual fees do come with some ‘add on’ benefits. The CVS card also includes 10% off of health services provided at MinuteClinic (which they own and are typically located in a CVS store) as well as discounts on flu shots and glucose testing strips, while Walgreen’s gives cardholders discounts of 5 to 20% on immunizations along with 10% of treatments at their own in-store clinics.
Drug discount cards can also be bundled with other healthcare services marketed to the uninsured or others without drug coverage. The telemedicine company I wrote about last week, Connect2Docs, includes a drug discount card among the four services it provides (the other three are a telemedicine service, free health screening, and medical bill negotiating service).
Getting the medicines you need is an important part of your health, and self-pay patients should look at drug discount cards as an important part of their healthcare cost savings strategy.
- Ways to Fill Your Prescriptions When You Are Strapped for Cash (savealittlemoney.com)