Given the high cost associated with most prescription drugs, it’s not surprising that many people choose not to fill a prescription or take it as directed in order to save money. A report from NCHS researchers discovered that about 8% of adult Americans do not adhere to their medications as prescribed because they cannot afford them.
As prescription drug prices keep rising, drug manufacturers have designed ways to reduce the out-of-pocket costs for patients. One way they do this is with copay cards. These cards help insured patients afford expensive prescription drugs that physicians determine are the best treatment options, especially when their insurance doesn’t cover everything.
Copay cards are not linked to financial need and can help reduce the total expenses for patients. Here’s everything you need to know about using copay cards to get your prescription drugs.
What are Copay Cards?
Copay cards are a form of cost sharing. Drug manufacturers use them to help patients offset the responsibility that is left over after insurance. These cards, also called discount cards, copay coupons, copay savings programs, or copay assistance programs, are provided by drug manufacturers directly to all commercially eligible patients. They usually apply to costly, brand-name medications that do not have a generic alternative.
When you present one of these cards at the pharmacy for your medications, your health insurance pays some of the cost. With copay cards, the manufacturer will cover the rest. They can be especially beneficial for those requiring expensive specialty drugs to treat their condition.
How does Copay Cards work?
According to research by USC Schaeffer, 79 percent of brand-name drugs do not have a generic alternative available, which makes copay cards a valuable resource for patients requiring help affording these medications for treatment. If a patient has commercial insurance, they may have the opportunity to obtain certain brand-name medications for a minimal (or zero) fee using a copay card.
The copay cards carry billing details used by the pharmacy when filling the medication. The pharmacy will process the card’s billing along with the patient’s insurance to offer a discount or credit towards their out-of-pocket expenses.
However, your health insurance company and the manufacturer that cover part or all of the cost you’re responsible for, have a cap on the amount they pay towards out-of-pocket costs per fill (e.g., max $150 per fill).
Where do you use Copay Cards?
Copay cards, designed to be used along with your commercial insurance plan, are accepted at most pharmacies, including online, physical, or mail-order ones, as long as they offer billing services.
How does one get a Copay Card?
For a copay card available for your brand-name medication, there are several ways to get one.
- You have the option to ask your pharmacist or healthcare provider regarding copay cards for your medications.
- You can access copay cards through the medication or manufacturer websites. It’s important to note that the website is usually the quickest and easiest way to acquire a copay card if you are not given one by your provider.
- Your prescribing doctor may have access to copay cards if they often prescribe a specific type of medication. (e.g., a specialist in diabetes treatment may provide copay cards for particular diabetes medications).
- You can ask your pharmacist about the availability of a manufacturer copay card for your medication.
- You can visit the non-profit site to locate the drug manufacturer‘s contact info.
How do you use Copay Cards?
To use a copay card, here are the steps:
- You can get a copay card from your provider, or pharmacist, or by signing up on the drug manufacturer’s website.
- Show your copay card to your pharmacist promptly after your medication is prescribed. Copay cards work like insurance and are billed before your medication is filled. If you wait until you pick up your medication to present the card, the pharmacy will need to re-bill it, which can cause delays.
- Your pharmacy will charge the medication to your commercial health insurance plan, which typically covers most of the medication’s cost. Afterward, the copay card will step in to cover some or all of your remaining copay.
What is the duration of validity for the card?
When you choose these copay card programs, the company issuing the card has specific parameters that determine its expiration. For many copay cards, there is an expiration date and a maximum savings limit. The specifics vary depending on the medication or companies, but generally, there is a monthly or annual maximum.
Some copay cards also have limits on how many times you can use them. Also, there may be laws that limit the use of specific copay cards depending on your location. In 2017, California prohibited the use of coupons in purchasing brand-name medications that have generic alternatives.
What are the requirements to get this card?
For most of the copay cards, there are two main requirements:
1. You must have commercial or private insurance.
2. You cannot have government health insurance, such as Medicaid or Medicare.
This restriction is enforced by anti-kickback statutes, which prevent manufacturers from inducing the purchase of items that could potentially be reimbursed by the federal government.
Do Copay Cards exist for every kind of medicine?
It’s important to note that copay cards are not available for every type of medication on the market. Typically, you will most likely find copay assistance programs for medications that are costly and relatively new to the market.
Also, you may encounter a copay card for a branded drug that has not been available for some time, especially if the patent for the drug recently expired and a generic or more cost-effective alternative is now accessible.
How do you redeem the Copay Card?
To redeem these cards, the patients must present them along with their prescriptions to the pharmacist. The pharmacist then enters the details into the system to process a claim.
Once all the necessary information is logged, the patients receive immediate coverage details, indicating their out-of-pocket expenses or co-pay. The details are shared with the benefit manager of the secondary insurance company, who then implements the discount. Finally, the pharmaceutical company covers the program cost, including any difference in the patient’s expenses.
Overall, copay cards help people save significant amounts of money when they require it most. Medical emergencies can unexpectedly arise at any stage of life, posing financial challenges.
How do patients and healthcare professionals benefit from Copay Assistance Programs?
Copay Assistance Programs lessen the patient’s financial burden, making it easier for them to obtain their prescription and ensure that the appropriate treatment is attainable.
Qualify Health specializes in the management of Copay Card programs. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team enrolls the patient into the Copay Card Program, monitors and submits EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.