Question: What are copay cards?

Copay cards function as drug discount coupons available for specific brand name medications with higher copays that help substantially reduce the out of pocket expenses patients must pay per fill. Only those who have a private insurance plan are eligible to use copay cards.1 This means that those on state or federal funding (i.e. Medicaid or Meidcare) do not qualify. A copay card is commonly treated as a secondary insurance for which the pharmacy bills after billing the primary insurance plan. Thus, it consequently covers a specific amount not covered by the primary insurance plan. It can only be used for a certain number of times or up to a specified yearly amount.

How can I obtain a copay card?

Copay cards can be obtained online through the drug manufacture’s website, your primary care provider, or your pharmacy can help you obtain one. Most copay cards involve registering online and then a card is issued which the pharmacy will need for initial processing of the prescription in addition to your private insurance plan information.

Several online resources for identifying medications that have copay cards available are GoodRx, needymeds, freecopay, and drug manufacturer websites such as Gilead.1 It’s important to keep in mind that some websites, such as GoodRx, do not offer copay cards themselves but contain links to drug manufacturer websites where you can obtain them. These websites, however, do offer discount cards (which differ from copay cards). Additionally, it’s also important to note that not all pharmacies accept discount cards.

How much can you save when using a copay card?

It depends. An example of a medication with a copay card available is Truvada, a medication for the treatment and prevention of HIV, produced by the drug manufacturer Gilead. The cash price for Truvada is around $1,989.57 for 30 tablets.2 Patients with private insurance can obtain a copay card through Gilead which covers up to $7,200 per year of the cost of the medication and no monthly limit thus essentially reducing their copay costs to zero for some patients.3 This is especially important for patients who are taking this medication long term as it helps improve adherence.

To delve deeper into further understanding copay cards, the following are two opposing viewpoints for and against the use of copay cards:

Pros:

  • Drug copay cards produce unarguable benefits for a large population of people who rely on lifesaving, high cost drugs for which no generics are available.
  • Copay cards improve access to medications that would otherwise be inaccessible due to substantially high costs. As some can relate, even small cost reductions can make a significant difference when it comes to affording medications each month since financial situations can change drastically.
  • Since patients can afford these medications, it helps improve medication adherence and can potentially translate to improved disease control and quality of life.
  • Copay cards are relatively easy to obtain and there are no fees or costs associated with obtaining or using one.
  • Copay cards are widely available for many brand-only drugs.4,5

Cons:

  • Since copay cards are typically offered through a drug manufacturer company, to compensate for the costs, the drug company may increase the cost of the brand name drug which could drive insurance costs and premiums and in turn increase how much patients must pay in the long run.
  • Some argue that copay cards are a way for drug manufacturers to establish brand loyalty for high cost medications. A good example of this is drug advertisements on TV which commonly advertise medication assistance programs for those who can’t afford their medicines.
  • Others state that it is discouraging the use of generics and causing patients to go against formulary recommendations for their insurance plan. A drug formulary describes what types of medications are recommended based on a patient’s medical conditions and other patient-specific factors, and is intended to provide doctors and patients a guideline on which medicines are most cost effective.
  • With a high demand for brand name medications, some drug companies may lose incentive to produce generics.
  • If a reduced amount of generic drug development occurs, this could result in a lack of price competition and thus the drug company for the brand name drug can hold onto the high price for the drug resulting in high healthcare expenditures.6,7

Is there a happy medium we can reach?

Although there is a considerable amount of controversy regarding this topic, there are steps that can be taken to obtain the most benefit from the copay card program.

One example is the prescriber, pharmacist, and the patient should always assess if there is a generic alternative available that is equally effective and has similar costs. That way the patient is still paying less, and we are avoiding rising premiums from use of brand only drugs. This would involve acting as stewards for copay cards and using them for their intended purpose. Note: If you are interested in understanding the difference between brand vs generic drugs please see the explanation at the end of this blog for more information.

At the end of the day, it’s about the patient…

The main idea of copay cards is to ensure patients can access the lifesaving medications they rely on without allowing all the complexities and high costs of the healthcare system to fall on the patient. Thus, at the end of the day what should really matter is ensuring patients have access to the medications they need regardless of cost, and to not have to settle for compromises. After all, health is something we cannot attach a price to.

 

Prepared by Lisa Georgiu PharmD Candidate 2020

References

  1. Looking for ways to save on Rx Meds? Co-pay cards and other resources. National Consumers League. National Consumers League; 2015 [cited 2019Aug15]. Available from: https://www.nclnet.org/co-pay_cards
  2. Truvada Prices, Coupons & Savings Tips. GoodRx; [cited 2019Aug17]. Available from: https://www.goodrx.com/truvada
  3. How can you get help paying for TRUVADA for PrEP®? How to get Truvada for Prep . Gilead Sciences ; [cited 2019Aug15]. Available from: https://www.truvada.com/how-to-get-truvada-for-prep/truvada-cost
  4. HealthPartners pharmacies save patients $1 million on medications using copay coupons [news release]. Bloomington, MI; July 30, 2019: HealthPartners. Accessed August 17, 2019.
  5. Traynor K. Insurers Restrict Copayment Coupons but Leave Coverage Explanations to Pharmacy Staff. News and Press Releases. ASHP; 2018 [cited 2019Aug15]. Available from: https://www.ashp.org/news/2018/09/12/insurers-restrict-copayment-coupons-but-leave-coverage-explanations-to-pharmacy-staff
  6. The Dark Side of Copay Coupons. Industry Updates. Express Scripts; 2016 [cited 2019Aug15]. Available from: https://lab.express-scripts.com/lab/insights/industry-updates/the-dark-side-of-copay-coupons
  7. Balick R. Copay cards save patients money but come at a cost. Pharmacy Today. 2016Dec [cited 2019Aug15];22(12):50. Available from: https://www.pharmacytoday.org/article/S1042-0991(16)31400-1/fulltext
  8. Center for Drug Evaluation and Research. Generic Drug Facts. Generic Drugs. U.S. Food and Drug Administration; 2018 [cited 2019Aug17]. Available from: https://www.fda.gov/drugs/generic-drugs/generic-drug-facts
  9. Van Nuys, Karen et al. A Perspective on Prescription Drug Copayment Coupons. University of South California. Published February 20, 2018. https://healthpolicy.usc.edu/wp-content/uploads/2018/02/2018.02_Prescription20Copay20Coupons20White20Paper_Final-1.pdf. Accessed August 17, 2019.