Prescription Coupons

Rachel Balick

They lower prices and increase access for patients. That’s good. They take precious time to process. That’s bad. They drive patients to pharmacies that accept them. That’s good. Increased traffic may not be enough to compensate for lost revenue generated by dispensing; immunizations; and safety, adherence, and wellness programs. That’s bad. Unfortunately, there’s no black and white when it comes to how manufacturer-sponsored, direct-to-consumer drug coupons and pharmacy network discount cards affect pharmacies.

Coupons and cards

Prescription drug coupons are issued by the drug manufacturer or pharmaceutical company directly to consumers. These discount cards are applied at the point of sale and insulate patients from higher copay costs of using higher-priced brand-name drugs. They can also be applied for patients without insurance, in which case the coupon will only lower the patient’s out-of-pocket costs up to the manufacturer’s specified maximum “out-of-pocket savings.”

Christina Polomoff, PharmD, BCACP, BCGP, is assistant clinical professor of pharmacy practice at University of Connecticut and an author of Pharmacists’ Experiences, Perceptions, and Knowledge of Direct-to-Consumer Prescription Coupons, a study published in the September 2020 issue of Journal for Managed Care and Specialty Pharmacy. To access the study, visit http://apha.us/DiscountCardStudy.

Manufacturer discount cards are controversial, Polomoff said, because of their potential impact on patient care and on drug expenditures: they can result in a higher premium and encourage brand loyalty for a medication that the patient may not be able to afford after the expiration of the coupon. That could mean a period of nonadherence.

“They also increase cost to the private insurer because the remaining portion of the drug cost after the discount is applied can be much higher than the preferred equivalent generic,” Polomoff said. “For this reason, these cards are prohibited in public insurance plans, including Medicare and Medicaid, who recognize that these coupons reduce generic utilization and thwart the prescribing of more cost-effective alternatives.”

Whereas manufacturer coupons are for a specific brand-name drug, pharmacy network discount cards apply to both brand and generic drugs. They are issued by vendors including GoodRx and Blink.

According to GoodRx, the company provides “curated, geographically relevant price comparisons and negotiated prices on prescriptions that have generated an estimated $20 billion of cumulative savings for consumers.”

There are drawbacks for patients using discount cards from GoodRx, Blink, and other vendors. “In the case of pharmacy network discount cards, the pharmacy cannot use the patient’s insurance coordination-of-benefit provision concomitantly,” Polomoff said. “This may result in a disservice to the patient in the long run because bypassing their insurance—essentially paying ‘cash off the record’—will mean that the patient’s out-of-pocket expense will not contribute to their plan deductible.” Use of discount cards can also make it difficult for a patient’s prescriber and insurance plan to ensure the patient is adherent to their drug regimens. That hurts plans, for which adherence is a criterion for their Star Ratings.

The good and bad

Several pharmacists interviewed for this story said they believed that their pharmacy paid a fee to GoodRx and similar vendors every time it processed a prescription through its cards. That’s not true. Pharmacies in the GoodRx network, for example, negotiate contracts and agree to accept a lower, out-of-pocket price for the drug dispensed to its discount card patient. In exchange, the pharmacy remains in its preferred network.

“Community pharmacies are incentivized to remain in discount card vendor networks despite revenue loss, as vendors encourage patients to move their business to contracted preferred pharmacies,” Polomoff’s study reads.

The pharmacists surveyed in Polomoff’s study overwhelmingly held positive perceptions for coupons’ and cards’ ability to increase patient medication access (91.7%) and reduce out-of-pocket costs (93.3%), and believed that community pharmacies should apply prescription coupons and drug discount cards whenever possible (84.2%).

Many pharmacists, however, say GoodRx and similar companies are a double-edged sword for their pharmacies.

“I can tell you our sales are down 30% over last year, but our script count is up 10%. I attribute a lot of that to the increase in patients using GoodRx,” said Annie Devereaux*, a pharmacy manager at a supermarket chain in the Midwest. “It’s hurting pharmacy’s bottom line but bringing new customers in the door.”

Devereaux said she’s had to devote more time to educating coupon and card patients—for example, explaining to patients why the price they paid last month may not be the same price they’ll pay this month—which has taken her away from her regular duties. Polomoff’s study estimates that community pharmacies spend an hour of staff time each day to process coupon claims. “We have a happy patient but a poor pharmacy,” Devereaux said.

GoodRx, for its part, emphasizes its intent to help pharmacies. “We love pharmacies—they are essential points-of-care for millions of Americans. We work with pharmacies on technology and marketing programs to help them attract customers,” GoodRx told Pharmacy Today.

Trust and sustainability

Mercedes Patrick*—a pharmacist at a high-volume pharmacy in the Midwest—laments that, in her experience, drug cards have eroded trust in pharmacists.

“I had a family member reach out to me to explain GoodRx and why his pharmacy hadn’t given him this option previously to help him save money. He felt betrayed as a senior that he was being ripped off by paying the price his insurance stated for his copay when he could have been paying less,” Patrick said. “I [had] to explain why my company tells us we shouldn’t ‘offer’ the coupons, though we do accept them.”

Patrick’s heavy workload makes it impossible for her to fully understand drug prices. It’s frustrating “not to understand how the pricing actually works and who is actually making profit here, and that all patients don’t have a simple, fair pricing structure,” she said.

Patrick also fears that her GoodRx patients’ information is being “mined” and their privacy compromised.

According to Polomoff, the legality of how patient information is stored, used, and transferred by prescription coupon and drug discount card businesses and their subsidiaries is not readily transparent. Some “terms of use” and “agreements” allow the companies to aggregate, store, and use patient-specific data.

GoodRx told Pharmacy Today that the company doesn’t threaten patient privacy. “Security and privacy of customer personal information are a priority for us, and we use industry standard processes and leading third-party vendors to help us develop and operationalize our security and privacy program,” it said. “We don’t require users to register or sign up to use GoodRx. We have never and will never sell our users’
personal health records.”

Blink, another network drug discount card vendor, did not respond to requests for comment for this story.

NeedyMeds is a national nonprofit organization that connects people to programs that will help them afford their medications and other health care costs. It also offers a discount card accepted by a network of approximately 65,000 pharmacies. “I like to say that we are the only drug discount card that doesn’t want people to use our card as their first step to saving. We prefer they check out our website for programs that provide medicines for free first and to use the drug discount card once they have exhausted all other options,” said Rich Sagall, MD, president of NeedyMeds.

“Unlike many other cards, individuals don’t have to register to obtain our card. Users don’t have a unique ID, their name is not on the card, and there is no tracking by individual,” Sagall said. The company does need information from users who request a plastic card, but only enough to mail it to them. “Since there is no registration or enrollment, we know nothing about patient’s health…we have no health information to sell or share.” NeedyMeds does, however, receive information about the medicine, the filling pharmacy, the prescriber, and pricing for each transaction.

*Not their real names