Also, it is argued that about 60% of the time manufacturer cards are for brand-name drugs that have lower-cost, generic alternatives. Medicare Part D or Medicaid patients cannot use manufacturer copay cards due to anti-kickback laws. When your copay card expires, you could be surprised with a big pharmacy bill. These ensure that only your reduced copayment will go towards your deductible, not the entire price of the drug. To further discourage the use of copay cards, PBMs have also implemented copay accumulator programs. For that reason, PBMs prefer patients to choose less-expensive drugs from the get-go. The patient’s pharmacy benefit manager (PBM) pays for the drug itself. The patient then pays a small portion of their copay or nothing at all, and the drug manufacturer will pick up the rest of the copay. When the patient shows the card to the pharmacist, the pharmacy processes the prescription using the patient’s insurance information as the primary payer and the copay card information as the secondary payer. Once enrolled in the copay program, the patient will receive a card from the manufacturer. Here’s how it generally works: patients sign up for a card through the manufacturer’s website. But while independent discount cards are used instead of insurance, manufacturer copay cards can be used with commercial or private insurance plans. Remember, as we learned in a previous blog post, prescription discount cards are not insurance.
What are these manufacturer cards? How can they offer such an expensive drug at such a low price? Let’s find out. That’s still too much.īut then you find a copay card from the manufacturer that would make your brand-name prescription only $25 a month.
It is approximately $1400 a month, and about $500 with your discount card. You ask the pharmacist about a generic alternative. This is the point at which many patients might give up and go home, completely abandoning their first fill. Undeterred, you pull out the prescription discount card that you’ve used before. It’s two thousand dollars for a one-month supply. Then the pharmacist says, “Are you aware of the price of this medication?” You didn’t question it, because you were grateful to have a potential solution to your pain. After months of testing, your doctor diagnosed you with ulcerative colitis and prescribed a brand name drug. Imagine you’re standing at the pharmacy counter. Check back later for a follow-up on generic drug savings programs and more, and see last week’s post on prescription discount cards. We’re covering manufacturer copay cards this week. Note: In updating our blog post on prescription discount cards, we determined it would be more useful to our readers to split this material into several posts.
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