Prescription Copay Cards
What are they? Why would you use them? What are their limitations?
Have you ever used a copay card before? I'm not talking about your insurance prescription card or discount cards like GoodRx. These are drug manufacturer savings cards that are designed to be used in addition to your insurance prescription card. They are particularly useful with medications that are expensive and generally have higher copays. Sometimes you may be able to use these towards your deductible as well depending on your insurer. You most likely will find these cards on 'Brand' name drugs and not generic drugs. However newer 'biosimilar' medications may also provide some sort of copay assistance. Biosimilars are biologic medications that are highly similar to and has no clinically meaningful differences from an existing biologic medicine. (i.e. Humira).
The best way to explain how these work I believe is to just show an example. First you receive a prescription from your provider. In this case, lets say your doctor is starting you on Xarelto, a medication used to reduce the risk of stroke in some patients with atrial fibrillation and also to treat and help prevent blood clots. Your prescription insurance formulary has Xarelto as a Tier 4 drug with a $75 copay per month. If cost is not an issue for you, you pay your $75 copay at the pharmacy and go about your day. However many people would not be able to afford that cost especially if you are on many medications and multiple copays. Another option is to speak with your provider to see if there are cheaper alternatives or a generic medication that can be used instead. The third option is to go to the drugs webpage. Search Xarelto in whatever browser you use on your computer and the manufacturers webpage should come up as one of the links. The Xarelto homepage loads and on the main page you will find 'Savings and Support'. From there you have a choice of links to choose whether you have government insurance (Medicare/Medicaid), commercial insurance (through your employer or private insurance), or no insurance. In this case you have commercial insurance and you see the manufacturer Janssen offers a $10 copay per 30 days. You can sign up online after being asked some questions and generally are able to print out your card to take with you to the pharmacy. Click here to see an example of the letter/card you get from the Xarelto program upon signing up. The pharmacy bills your commercial insurance ($75) and then bills the copay card to bring your cost down to $10 for a 30 day supply for a $65/month savings! There are limitations to many of these programs especially those with government or no insurance. It is important to read and make sure you meet all the eligibility requirements. In Xarelto's case, the $10 copay does not apply to government funded, Medicaid, or Medicare. Interestingly enough, Xarelto (Jannsen) is coming out with a savings program that can be used in addition to government issued insurance (mostly benefits government workers and Medicare patients) starting in April 2023 per their website but the majority exclude government sponsored, Medicaid, Medicare or the uninsured.
Now your probably thinking, thats a lot of work! It's not and so easy. Just remember you are signing up for their program and are giving your personal information to them. Some people are adamant about not divulging personal info but is usually required per the terms of use for the savings. Make sure you read what you are signing up for.
Manufacturer's usually have some sort of patient assistance program to help low income and uninsured patients as well. These are programs you will have to be approved for, are more labor intensive on your part, and different from copay cards.
Each program is different and may have maximum monthly or yearly benefits. In our case above, the limitation is : "There is no limit to this benefit for the first 90 days, and then a $200 limit for each 30-day supply thereafter. There is a $3,400 maximum program benefit per calendar year. Terms expire at the end of each calendar year and may change."
Hopefully you found this article useful.
Disclosures: Remember this article is for informational and educational purposes only. This article is in no way intended to imply your insurance copay is $75 or even covered at all under your insurance formulary. I receive no compensation from Xarelto or Jannsen and have only used for the purpose of an example. Finally, I am NOT your doctor or pharmacist. Always discuss medication options with your provider or pharmacist. In no way does this article give medical advice.
