Why do discount prescription cards work?

[Wade Lippman]

Yes, it is an odd place to post this question, but I don't know of a better place. Hey, someone might understand this.

I got a prescription that was $85 retail and $58 on my Medicare Advantage plan. I tried three discount plans and the came up $12, $18, and $20. I used the $12 and got it for that price. I filled a 2nd prescription at the same time; it was $11 on my plan and $50 on the discount card.

This seems bizarre to me. How can a discount card get it for me at 85% off (presumably make a couple bucks for themselves also) while my insurance was so much more. And just the opposite on the other drug.

Anyone understand why this works?

[Rod Sheridan]

Beats me, I don't even know what a prescription discount card is..........Rod.

[glenn bradley]

People are frequently confused by the insurance company’s business model. It is advertised as providing you a service. The business model actually consists of collecting premiums; as large and as often as possible.

[Mel Fulks]

It is providing a service. They don't say "free service". Anyone who bought it and later had a lightning caused house fire
has been glad they bought it.

[Alan Rutherford]

The prescription cards, discount coupons and free offers I've looked at almost always don't apply to people on Medicare or a Medicare Advantage program. They often don't apply if you have any relevant insurance. You might have gotten away with something when you used it. As to how they make money - Drug prices are so artificially inflated in most cases that making money isn't hard. There's enough for everybody and the only question is how it gets split up and of course how much you end up on the hook for.

[Bob Turkovich]

I'm on Medicare and have Plan D prescription coverage. A month ago I used "Good Rx" to pay for a one-time prescription (i.e., not a daily maintenance drug) and it saved me about 75% over the Plan D costs and could be determined over the internet. Purchase was done at Costco for this particular script but CVS - using the Good Rx coupon - would still have been a 60% savings over Plan D.

I have not received any further solicitations from Good Rx so I don't what's in it for them.

Reminder - Coverages and costs for Medicare plans vary from state to state.

[mike stenson]

Cash rates are, IME, almost always lower than insurance rates anyway. Most insurers require a pretty stiff discount, so the prices reflect that (they're raised, so that they can discount and not lose money).

[Ron Citerone]

Had some crazy discounts from Good RX compared to my old plan. Never made sense. New plan always beats Good RX. The whole system is purposely opaque IMO.

I was told Phamacists are not allowed to tell you it is cheaper on a discount card. Never varified that though.

[Bruce Wrenn]

Years back, was on a "brand name" prescription. Co- pay was $72. Pharmacist told me I should pay cash instead of insurance, so I asked cash price. It was fifty four dollars, a savings of eighteen dollars. Pharmacist explained that insurance didn't pay retail price either. They had to send difference back to insurance company. I was being charged for using insurance which I had already paid for. In any other business this would be called fraud. Same thing for lab work. Insurance paid total bill, but I needed to pay a forty dollar co-pay beyond total of bill. Wife recently got a new antibiotic. Co-pay at CVS was $47. With Good Rx, it was $12 out right at local grocery store. Many insurance companies require a "Gag order" on prescription prices, so you don't know you are being ripped off.

[Stan Calow]

>....I was told Phamacists are not allowed to tell you it is cheaper on a discount card. Never varified that though.

I believe that is true in many states. I had a prescription that insurance would not cover. The retail cost was quoted at $79. I asked the pharmacist if there was any discount available and she told me she could not say. I got it for <$20 with a GoodRX card which the doctor recommended.

[Brian Elfert]

I am on two medications with 90 day refills. My employer switched insurance companies this year and my out of pocket cost for the medications doubled or tripled. I just checked my pharmacy claims for the year and it looks like insurance didn't actually pay anything because the costs are less than my pharmacy co-pay. At $14 a month I haven't worried too much about the cost going up. These are common generics so I should see if could get them cheaper paying cash.

[Brian Tymchak]

Ohio recently passed regulations to revoke PBM gag orders that pharmacists were forced to obey about providing cost info to patients.

[Wade Lippman]

I might have a partial answer to my question! My plan has $300 deductible on class 3 drugs. So probably paid nothing for the transaction in question because I have never had a class 3 drug. But it doesn't explain why GoodRX negotiated such a better price than UHC did.

[Jim Koepke]

One of my employers was notorious for being slow in paying their bills. One day on the way to work to purchase some tools the clerk noticed my uniform with my employer's emblems. He was going to give me the business discount even though this was a purchase for personal use. He then informed me the over the counter price was better than what they would charge my employer.

Some discounts are better than others.

jtk

[Brian Elfert]

One of my employers was notorious for being slow in paying their bills. One day on the way to work to purchase some tools the clerk noticed my uniform with my employer's emblems. He was going to give me the business discount even though this was a purchase for personal use. He then informed me the over the counter price was better than what they would charge my employer.


I called a place from my work phone a few years ago to ask if they had an item in stock. They assumed I was calling to buy for my employer based on the caller ID. They said they would extend me my employer's discount which resulted in a 50% savings on my next order. Not everything is discounted that much, but some things are.

[roger wiegand]

Discount cards and such are all about getting you to fill the scrip. It's marketing. 90% of people with good insurance probably never look twice or ask about the prices of their prescriptions. The other 10% are the targets of discounts, cards, programs, etc etc. The price-sensitive folks will often not fill a marginally needed prescription, if they can be induced to do so with a promotion that's a win for the pharma company. (who still makes money, even at the discounted price).

Long ago I interned in the marketing strategy department of a major pharma company. A lot of time and energy went into ideas to improve "fill rate". Marketing strategy in pharma is all about filling as many prescriptions as possible at the highest price that each particular consumer will pay for that prescription. -- up to and including the time-tested "the first one is free" pitch.

[Alan Lightstone]

Don't get me started about pharmacy benefits managers who are middlemen who screw both the insurance companies and the consumers, all in the name of "saving money" which is the opposite of what they do.

60 Minutes did a piece on them about a year or so ago. Ripped into the I believe 2 PBM companies who control the market.

They are slime. Basically, GoodRx still makes money on your massively discounted prescriptions. Which shows you just how high the markup really is.

Now our insurance company won't deduct the cost of a prescription you use the pharmaceutic companies discount card to fill (usually those $0 cost coupons on their websites) from your deductible. So, essentially, you never reach your deductible if using discounts.

There isn't much either of these two types of companies haven't thought of to abuse the consumer.

[Brian Tymchak]

Don't get me started about pharmacy benefits managers who are middlemen who screw both the insurance companies and the consumers, all in the name of "saving money" which is the opposite of what they do.

60 Minutes did a piece on them about a year or so ago. Ripped into the I believe 2 PBM companies who control the market.

They are slime. Basically, GoodRx still makes money on your massively discounted prescriptions. Which shows you just how high the markup really is.

Now our insurance company won't deduct the cost of a prescription you use the pharmaceutic companies discount card to fill (usually those $0 cost coupons on their websites) from your deductible. So, essentially, you never reach your deductible if using discounts.

There isn't much either of these two types of companies haven't thought of to abuse the consumer.

Amen brother. The PBMs are firmly entrenched into the Ohio medical support programs (Medicaid, Medicare) and it's been documented that they suck out about $180M a year from taxpayers. Unfortunately they have the plenty of state politicians in their pockets so revamping the system is not going to happen anytime soon.

[Bill Dufour]

Medical pricing is insane. The insurance companies pay it because they see the cost benefit relationship.
Redemisphere costs under one dollar a dose to make. It sells for over $300 a dose. If it keeps a covid patient out of the ICU for one day more it saves the insurance company thousands. They can sell it with a 50% discount and still make a nice profit after development costs as long as there is no decades long class action suit claiming it made many male patients loose their hair 50 years latter.
Bil lD.

[Michael Weber]

I recently mentioned transitioning to Medicare from a discontinued employer retiree medical plan. After deciding on my medical coverage I started investigating drug plans. It’s crazy. That’s about all I care to say about it.

[Mike Null]

The GoodRX card works whether you have insurance or not. My 5 prescriptions are free with my Medicare Advantage plan but certain drugs which are not on the tier 1 plan can cost a fortune. I use the GoodRx card to buy Lidocane patches and I save about $100 per box of 30.

[Perry Hilbert Jr]

Years ago, I stopped to buy an inhaler for my step son. My medical insurance hadn't kicked in yet and the clerk told me the price and I paid cash with no insurance. It was something like $12. a month later I stopped at the same pharmacy to get another of the exact same thing. But this time I had insurance. The charge was $18. I complained to the clerk and they said that was a mistake. I went out to the car and got the old receipt out of the glove box and went back in. The Clerk turned beet red. I ended up talking to the pharmacist who gave me the wildest cock and bull story about the insurance contract saying that is what they were required to charge people with that coverage. I called the insurance company about it, and was told that wasn't true. I never went back to that pharmacy, couldn't it was closed a month later. My wife has very good insurance now that covers me. I pick up all her prescriptions. She has been getting the same one every month for at least 4 years. Some months it is $1.50, the next it it $4, then back down to $2. Makes no sense.

[Brian Elfert]

I went to the ER on Jan 1 and when I went to the hospital pharmacy to get my prescription my new pharmacy insurance wasn't working yet. Retail price was something over $50. The pharmacist said they would run it through a discount card and it came out to under $10!

[dennis thompson]

People are frequently confused by the insurance company’s business model. It is advertised as providing you a service. The business model actually consists of collecting premiums; as large and as often as possible.

Yes, and my model consists of paying as little as possible, as infrequently as possible, this is a friction between buyer and seller just naturally exists in our society.

[Scott Winners]

Once upon a time, late 1990s or early 00s, I ran across a new drug in my clinical practice that worked really really well. At the time I was young, single, had money, owned a few stocks and I went looking at the drug maker to see about buying some stock.

I ran for the hills. I looked at a few more pharmeceutical companies after looking at the first one and was just appalled. At the time, the vast majority of a pharmaceutical company's operating profits went into research (good/supportable) and lawsuits with other pharmaceutical companies. I haven't looked at the "investors page" of any pharma company lately, but the big ones should all have an "investors" button on the home page if you want to see their balance sheet, where they are spending their money.

[Brian Deakin]

I live in the United Kingdom The cost price of generic drugs is set by the Uk Government If you would like to compare the cost price of drugs in the UK Please see the link below

http://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD00791615/Home

and scroll down to


Part VIIIA - Basic Prices of Drugs Product List



Part VIIIA products A
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Part VIIIA products Y
Part VIIIA products Z


The prices are in UK pence example Baclofen 10 mg cost 158 .....means 84 tablets cost £1.58 or $2.05

[Dave Lehnert]

My mom is on an RX. $460 but with a discount card $10.