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Health Care Hacks Ep. 3 – Paying for Prescriptions

Famed healthcare company GoodRx is a well-known resource to patients nationwide, especially when it comes to finding information about and discounts on medications.

The companys latest venture into healthcare is through its launch of GoodRx Gold, a membership based healthcare savings program. Earlier this week, the company outlined the details of how it plans to enhance the service. As a means to augment its existing prescription medication savings offerings, the new Gold plan will provide members with the ability to: See a doctor or healthcare provider online for as little as $10 per visit Get treatments and prescriptions for conditions ranging from acne to high cholesterol Use GoodRx app or discount card to save big at the pharmacy counter Get prescriptions delivered to door without leaving home.

Indeed, the company is aiming to create an end-to-end healthcare service platform, starting with connecting patients to clinical providers, to ultimately getting discounted prescription medications delivered to the patients door.

With regards to affordability and the logistics of signing up for the plan, the company states that Online consultations are available now on individual GoodRx Gold membership plans, and will be available on family plans starting in 2021. A subscription to GoodRx Gold is just $5.99 a month for an individual and $9.99 a month for a family of up to six.

Can I Use Goodrx If I Have Insurance

While anybody can use GoodRx without membership or registration, GoodRx discounts cannot be combined with health insurance. Its also important to note that GoodRx itself is not insurance.

According to the company, Paying with a GoodRx coupon is considered an out-of-network purchase, and its up to the insurance company to decide if theyll pay you backor whether theyll count it toward your deductible. Therefore, employees can try to get reimbursed for the prescription through insurance post-purchase, but its not always eligible.

With certain health insurance plans, employees might have a deductible for prescriptions that makes the plan holder pay full price for the prescription until the out-of-pocket maximum is reached, according to GoodRx. The company also explained that employees might lack coverage entirely or have to pay a higher copay if their medication is on a higher formulary tier or is a non-preferred drug.

Check The Discounted Medication List

Some retailers offer a list of generic medications at low prices. A few examples include:

  • Walmart: Walmart offers some prescription drugs at $4 for a 1-month supply or $10 for a 3-month supply. There is no membership fee to access these savings.
  • Walgreens: The Walgreens Prescription Savings Club offers value-priced medication in 1-month and 3-month supplies. Pricing varies based on a medication tier. To access these savings, theres an annual membership fee of $20 for individuals and $35 for families.
  • Kroger: The Kroger Rx Savings Club offers select medications for $6 or less for a 1-month supply. Theres also an annual membership fee involved, which is $36 for individuals and $72 for families.

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Do You Take Medications Not Covered By Medicare

Simply go online to the GoodRX website and enter the name of the medication. Good RX will tell you which pharmacy near you offers the best price and if there are any coupons available that can save you money. Sometimes you find you are already getting the best price and other times you may find their coupons can save you a lot of money!

Visit GoodRX to see if you can save money on your Medications

How Does Goodrx Make Money As A Business

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GoodRx has several income streams that bring in over and estimated 100 million in earnings each year according as of 2018. The actual numbers arent publically available since the company is privately owned. The income streams include:

  • PBM administrative fee sharing
  • Data collection services and information sales

Ill discuss each of these in detail below.

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How The Company Makes Money

GoodRX makes part of its revenue by collecting fees from the pharmacy benefits managers, or PBMs, it works with when consumers present their GoodRx coupon at the pharmacy.

PBMs are middlemen that fit into the notoriously complicated drug supply chain, where they negotiate prices with manufacturers on behalf of insurers.

In a very simple example, imagine a patient pays $20 for a drug. The PBM might collect $6 from the pharmacy, leaving the pharmacy with $14 . The PBM then splits some of that fee with GoodRx.

Independent pharmacies will sometimes make money on the transaction, but not always. For that reason, some of them have started their own rival discount programs or work with a different contractor that is offering to reduce the fees. But GoodRxs Hirsch claims that overall, the service is financially positive for pharmacies.

A lot of times you can end up losing money when a customer uses a discount card, said Steve Moore, a pharmacist with Condo Pharmacy in New York. But it depends on the drug.

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An Industry Cloaked In Secrecy

As it turns out, Hirsch’s experience is pretty standard. Most Americans don’t know that prices can vary wildly from pharmacy to pharmacy.

“Most Americans are buying blind. They don’t know how much a drug is going to cost when they get a prescription … and they don’t know that they might be able to get it for less if they just pay cash or walk into another pharmacy,” said Robin Feldman, a law professor with a focus on intellectual property and antitrust at UC Hastings College of Law and author of “Drugs, Money, and Secret Handshakes.”

This is becoming an increasingly critical issue as drug prices in the U.S. spiral out of control. Even after rebates, Medicare spending for brand-name drugs rose 62% between 2011 and 2015, says Feldman. The prices of the 20 most commonly prescribed brand-name drugs for seniors have risen nearly 10 times more than the annual rate of inflation over the past five years, according to a congressional report released earlier this month.

Prices are continuing to rise. According to a quarterly report from GoodRx, the average list price of drugs that’s the price set by the manufacturer rose 2.9% in the first quarter ending March 31, 2019.

Rising drug prices have many patients and doctors very concerned. The consequences are alarming. And bad for everyone.

Americans are struggling to pay for prescription drugs which have huge consequences for their health.Robin FeldmanLaw professor at UC Hastings College of Law

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Insurance Carrier Website Or Customer Service Phone Line

Many insurance carriers include a Part D medication look-up tool on their websites. So you can get pricing pretty quickly online.

And you can of course call the insurance carriers customer service phone line to verify pricing. This wont be the quickest route, though, as youll likely have to wait to get a live person for assistance.

What Is Goodrx Gold

Drug prescription prices

GoodRx Gold is a monthly membership program that claims to provide even greater discounts on prescription drugs and health services. The program boasts 1,000 prescriptions for under $10 at pharmacies across the country. Similar to GoodRx, all you need to do is show your card or mobile app when you fill a prescription at any participating pharmacy. GoodRx Gold cannot be combined with insurance.

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Why Cant I Use Drug Manufacturer Coupons If I Have Medicare Part D

The Anti-Kickback Statute was enacted as a deterrent to stop fraud and abuse in the healthcare industry. This legislation made it illegal for companies to exchange anything of value to generate business that would be reimbursable by federal healthcare programs like Medicare and Medicaid.

Within the pharmaceutical industry, the Anti-Kickback Statute made it a crime for pharmaceutical manufacturers to offer drug coupons to Medicare beneficiaries. This is because it became illegal to influence the purchase of any prescription drugs that Medicare could later reimburse.

If youre enrolled in Original Medicare or a Medicare Advantage plan and also have a prescription drug plan :

  • You cant use both a drug discount coupon and your Medicare prescription drug plan.
  • You can use a drug discount coupon instead of your Medicare prescription drug plan.

If you are in the coverage gap, or donut hole, for your Medicare prescription drug plan, you may be able to use the Medicare Coverage Gap Discount Program.

Most Part D plans have a coverage gap, which occurs after you and your plan have spent a certain amount on prescription drugs. This amount changes each year but is $4,430 for 2022.

While in the coverage gap, youll pay a certain percentage of your prescription costs out-of-pocket until you reach a specific yearly limit.

Goodrx Alternatives That You Can Trust

Personal favorite is SingleCare, you can ready why in my in-depth review or you can read my article on how GoodRx and SingleCare stack up side by side. You can see other recommended options on my recommended products and services page including ways to get steeply discounted prices AND have the medications shipped directly to your house.

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Can You Use Goodrx With Insurance

No, you cannot use GoodRx with insurance. While it may be used in place of insurance, you cannot use both at the same time. If you are considering using GoodRx, check with your health insurance provider to see if they offer a better generic or brand name medication price. Generally, your health insurance copay will be significantly less than the cash price.

In addition, there may be times when you can save money on your overall health care costs by using your insurance even if the GoodRx price is lower. This is because using insurance will count toward your deductible and reduce your overall yearly healthcare costs. Ultimately, consider all your healthcare costs throughout the year and make a decision that fits your individual needs.

Question Why Do I Need A Prescription Drug Plan If I Can Get My Medications Through Goodrx

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Question Why do I need a prescription drug plan if I can get my medications through GoodRx?

Answer I have been hearing about GoodRx more and more. I see the commercials continuously on the TV and in magazines. I have many clients ask me about GoodRx.

First, let me clarify why you need a Prescription Drug Plan? If you are eligible for Medicare and enrolled in Medicare Part A or Part B or both, there is a law that requires you have Prescription Drug Coverage. There is a minimum standard plan that your Prescription Drug Coverage Insurance must meet . If you dont have that Minimum Standard Prescription Drug Coverage, there is a penalty that is enacted for the months you dont have that Prescription Drug Coverage, if you decide to enroll later.

What I am trying to convey is that if you have Medicare or are eligible for Medicare, you should have some sort of Prescription Drug Plan .

When we work with seniors to find the best possible prescription drug coverage for them, we evaluate the plans based on where they prefer to buy their medications, what medications they take, and what their other healthcare needs are. We do this using the www.medicare.govwebsite.

I do recommend looking up the GoodRx pricing before you are standing in line at the pharmacy. You need to be aware of what GoodRx can do for you, but you should not stand at the register trying to figure all this out, while other customers line up behind you.

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Does Goodrx Sell Personal Medical Data

GoodRx says it makes money from advertisements and referral fees, not by selling your personal medical data. Thats something the company says it wont do.

However, GoodRx does data in some cases. Heres how the company puts it:

Its common practice for companies to share data for advertising and analytics purposes, which is what GoodRx does. And the small amount of data that is shared cannot be linked back to an individual person, a GoodRx spokesperson said in a statement to GoodRx has also gone above and beyond in implementing an opt-out and data deletion feature that is available to all users.

GoodRx implemented the opt-out and data deletion feature after a Consumer Reports investigation. Heres how you can opt out of cookies and tracking.

Data Collection Services And Information Sales

GoodRx collects information both through its software and via the information the pharmacy sends to the PBM when it adjudicates a prescription claim . They use this information to sell HIPAA compliant, aggregate information to outside vendors like drug companies and PBMs to track drug utilization, pricing, and other trends.

If you are concerned about your privacy this might be very concerning given the discoveries revealed by Consumer Reports recently. GoodRx states they store your information in a secure manner but you know like every other company this security may be breached at some point. The good news is they are required by the HIPAA regulations to disclose what personal information they have on you if you request it.

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Goodrx Vs Insurance: Which Should I Use

Benefits & Healthcare 3 min read time

While individuals might have prescription coverage through their employer-sponsored health plans, they might still face high costs for their medications depending on the drug theyre prescribed and what kind of plan they have.

In some cases, there might be even more savings available to them through GoodRx, which allows individuals to save money on prescriptions without any registration or membership cost.

How does GoodRx work, and can employees use it with their insurance?

Goodrx Finds Coupons And Discounts On Prescription Drugs: Heres How It Works

Why Patients Should Discuss Cost of Care

GoodRx is a website and mobile app that finds discount prices for medications and tells you where to get the lowest price. It does the comparison shopping for you!

I previously wrote about how I combined discounts from GoodRx and pill splitting to lower the annual cost of one medication that I take from nearly $158 to just over $36!

Read on to learn more about GoodRx and how it can save you some money.

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Can You Use Goodrx Coupons With Medicare Part D

GoodRx Coupons and Medicare Part D cannot be used in conjunction. This is due to a federal government statute, also known as anti-kickback, that prohibits Medicare beneficiaries from using manufacturers or discount drug coupons with their drug plan. However, you can use GoodRx in place of your prescription drug plan.

Goodrx: A Free Tool That May Help You Save On Your Prescription Medications

We routinely go online to compare prices for hotels, rental cars, and airline flights so why not do the same for our RX drugs? This is where a company called GoodRX really shines. GoodRX is a free service that provides discounts on thousands of medications and can help you compare drug prices at different pharmacies. While GoodRX is not a replacement for your Medicare prescription drug plan, it may help you save money on some of your medications, especially those that arent covered by Medicare. Occasionally we have even found that coupons from GoodRX that offer lower prices than the copays in a Part D Drug plan!

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Goodrx Doesnt Show You The Absolute Best Price Available

Like any company GoodRx has its best interest in mind so it only displays the pricing of its partners or the paying advertisers. You wont find the free medication lists from several pharmacies displayed on the GoodRx pricing page since those pharmacies havent paid to have them advertised on GoodRx. You also wont find the extremely discounted prices from competitors like Blink Health or SingleCare.

How Does Goodrx Make Money

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Many users ask themselves how this money-saving platform can offer such great discounts. Its easy. GoodRx partners with almost all Pharmacy Benefits Managers in the country. This way, they can negotiate awesome deals you wouldnt otherwise have access to.

GoodRxs revenue comes from several streams. The main ones include ads run on their website and apps, membership passes, and commission from prescription drug sales. Of those three, the third one is the most substantial.

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Can I Use Drug Discount Services With Medicare

Drug discount companies are free services that help both insured and uninsured individuals save money on prescription drugs. These companies negotiate drug prices directly with pharmacies, which then pass along savings of up to 80% off the retail price to the consumer.

Prescription drug discount cards are free to use for Medicare beneficiaries who choose to pay out of pocket for their medications instead of using their drug plan.

In some cases, these drug discount companies may offer the drug at a lower cost than your Part D formulary. In this case, you can choose to pay out of pocket for the drug instead of using your Medicare plan.

Some drug discount programs to consider using include:

Before you use a drug discount card, visit the website of the program you want to use and perform a prescription drug search. Searching for your medications through these program websites can help you determine if and where your drug will be discounted.

No matter how you pay for your prescription drugs, theres no double-dipping when it comes to discounted medications. Youll need to choose either Medicare Part D or a drug discount program when you pay for your prescription drugs.

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