Cost of medications and healthcare in general is climbing and it is becoming a real hardship to pay for the medical care you need.
How it Worx:
Co-pay cards are discounts off of your co-pay for drugs you want. Pharmaceutical companies are willing to pay a portion of your co-pay in order to incentivize you to purchase their drugs at the pharmacy.
*co-pay assistance cards apply to private insurance or cash pay patients only and not government programs like Medicare, Medicaid, Tricare, etc
- You will pay less at the pharmacy for your co-pay (sometimes $0).
- The entire co-pay amount you would have paid goes toward meeting your out-of-pocket deductible as if you had actually paid it.
Example (If a prescription deductible does not apply)
If your were buying one box of Toujeo Pens for $300 and Toujeo is covered by your health insurance at a 20% co-pay, then your copay would cost $60.
The Toujeo Savings Co-pay card discounts your co-pay down to $10 for the prescription. In this example, you pay $10, you save $50 at the pharmacy and $60 goes toward meeting any deductible or out-of-pocket costs.
$10 out of your pocket, Toujeo in hand, and $60 closer to meeting your deductible …not too shabby.
But…that’s not all! Let’s say instead of Toujeo you were using Lantus insulin and you still needed to meet a $1000 pharmacy deductible. The co-pay card will pay all of your co-pay costs! That is a $0 co-pay and $300 closer to meeting your deductible!
Why do they do it?
Pharmaceutical drug companies charge high prices for their medications and will get paid mostly by the insurance companies. They try to get market share by discounting the cost of drug X to you (via the co-pay card) to incentivize you to buy their product at the pharmacy. They then get paid the allowable amount billed to your insurance. This allows drug companies to get their foot in the insurance door, if you will, by showing the insurance companies there is a demand for the drug. Simply put, increasing the demand pushes insurances companies to review the drug for formulary placement.
Our co-pay card spreadsheet will show you what diabetes medication cards are available to you and the co-pay card terms. Otherwise, you will need to get the co-pay assistance card from the pharmaceutical company on their site and search for co-pay assistance cards.
- If searching on your own, make sure that you are actually on the drug company website, as there are many counterfeit sites online.
- These cards would work at your 3-month mail order companies, however many mail-order companies will not process them. A local pharmacist is usually your best option.
- Only occasionally some pharmacies will not accept these cards, however from my experience most do.
- When returning for refills, remind your pharmacy that you have the co-pay discount card every time you go. Also, keep the card info with you in case they don’t keep it on file.
If your insurance requires that you meet a medication deductible, then usually the card helps only a little. For example, if an insulin costs $270 and you have a $3000 prescription deductible, then your insurance would not pay anything until the deductible is met. If the card has a benefit up to $300 then no problem, however if the card has a benefit up to $100, then you are paying the rest.
Not on the Formulary
Another common issue with these cards is if your medication is not a covered benefit on your insurance plan. Weather the co-pay card worx for non-covered drugs, depends on the co-pay card terms set by the pharmaceutical company. If drug x is not covered, you will pay for the total cash price of the drug minus the co-pay discount (if allowed under the terms). Check the details of the card to see if Drug X must be a covered benefit (AKA on your formulary) in order for the card to work. (Confused yet- A list of diabetes drugs and their co-pay cards, terms and conditions are found on the co-pay card discounts table.)
Government Plans Not Eligible
Any government insurance plan such as Medicare, Medicaid, Tricare, etc. are ineligible for these types of cards. Many cards, to adhere to this condition, will exempt anyone over age 65 to make sure they are compliant to this condition.