Drug Co-pay Cards & Coupons

Drug co-pay cards and coupons and their impact on benefit plan costs

We’re used to using coupons for anything from free movie admission to cereal. What’s not to like? They’re easy to use and you save some money. But since when have coupons for prescription drugs been popular? The fact of the matter is they’re quite common but drug coupons don’t work quite the same way as a other coupons.

Using drug coupons 

Typically, patients get drug co-pay cards or coupons, from their physicians but they’re also available from other sources including pharmacists and the drug manufacturer’s website.

Co-pay cards or coupons for the most part, are available for brand name drugs only. When the pharmacist bills for the medication, he/she uses the card like a pay-direct drug card to electronically direct part of the patient’s cost (coinsurance, deductible or co-pay) to the manufacturer of the drug. Sounds good so far, right?

The thing is, co-pay cards or coupons might actually cost the benefits plan:

• In an environment where generic equivalents can cost as little as 18% of the price of their brand name equivalent, a $30 coupon doesn’t go very far when the cost of the brand name drug is $100.
• Some co-pay cards and coupons are designed to be the payer of last resort. That means the drug manufacturer is the last payer after the drug plan has paid.

For example:

Jim’s doctor writes a prescription for Crestor with ‘no substitution’ indicated on it along with a $30 Crestor co-pay coupon to help pay for the cost of the medication.

Jim’s coinsurance is 20% and includes regular generic substitution.

Scenario 1:

Jim has coverage through his own group plan as well as his spouse's

Crestor cost $100

Plan cost $80

Spouse's plan $20

Amount paid by coupon $0

Scenario 2:

Jim has coverage under his plan only

Crestor cost $100

Plan cost $80

Amount paid by coupon $20

We have a fix!

Many drugs are available in both generic and brand name forms. Generic forms are typically less expensive but are just as effective as brand name forms. They’ve been approved by Health Canada as equivalent and have the same active chemical ingredient, same dosage strength and same dosage form.

A fail safe solution to avoid unnecessary drug claim costs is implementing Great-West’s Enhanced Generic Substitution into your plan. This plan design element ensures that reimbursement is limited to the cost of the generic version of the drug (even in situations where the prescribing physician has indicated ‘no substitution’ on the prescription). 

Here’s what happens when Great-West’s Enhanced Generic Substitution is implemented into a plan. 

Scenario 3:

Jim's plan includes Enhanced Generic Substitution (EGS)

Crestor cost $100

Plan cost $23 (cost of the generic version)

Amount paid by coupon $30