Discover The World of Copay Cards:
- The Question Becomes What are Copay Cards?
- How do Copay Cards Work?
- Getting a Copay Card
- What Are the Requirements and/or Restrictions?
- They Aren’t Loved By Everyone
Copay cards are not synonymous with prescription assistance programs. While the purpose of both programs may be admirable the differences are noteworthy.
It is no secret prescription drug prices continue to rise. Simply look at when the government announces the social security check increase. Drug prices seem to go up right in lock step.
Patients not only notice the uptick but feel it in their pocketbook. Hence, they look for ways to save on their medications. Their insurance may not cover the added cost.
If that happens, a copay card may help offset some of the costs. A Copay card is a manufacturer based card issued directly by the drug companies. Their main purpose, at least as advertised, is to help patients afford expensive brand drugs.
The Question Becomes What are Copay Cards?
Copay cards wear several names. They are called copay savings programs, copay coupons, or copay assistance cards and manufacturer copay cards. No matter their name they are savings programs offered by drug makers.
They are designed to help patients reduce their out-of-pocket costs. One example would be if your doctor prescribed a digestive health medicine for you. That’s how they mirror patient assistance programs. A noble purpose indeed.
These cards or coupons are almost exclusively for the expensive brand name drugs. These drugs do not have a generic equivalent. Keep this in mind, it is important to know.
How do Copay Cards Work?
Note that the underlying purpose behind copay cards is to reduce the total out-of-pocket expense for the patient.
That begs the question, “What are the mechanics put in place?” when you present your card.
The mechanics are actually quite easy to understand. Your health insurance and the drug manufacturer share the cost. Your health insurance pays some of the cost as you might guess. The drug manufacturer being the other half of the equation. They pay part or all of the cost you’re responsible for through your copay or coinsurance.
Some insurers do not cover your particular drug. It simply isn’t in their formulary. If you are in that boat, the manufacturer will simply cover all or some of your costs.
How Do I Get A Copay Card?
Just like a PAP (patients assistance program), the access point is through the manufacturer’s website. In some cases, it is the medication website. Yes, they do set up websites for specific medications.
There is no guarantee your doctor or pharmacist will be familiar with copay cards. That should not stop you from asking either or both. The more information you have the more money you should save.
You simply follow the instructions on the website. Some even provide a toll free number for your convenience. Once you are enrolled, you probably will be provided a card to print out. If not, watch your mail box.
What Are the Requirements and/or Restrictions?
The 2 main requirements for most copay cards are:
- You must have commercial or private insurance.
- You cannot have government health insurance, such as Medicare or Medicaid.
The government has passed anti-kickback statutes to protect the consumer from manufacturers who would induce purchases so they could be reimbursed by the federal government. This keeps prices down or at least that’s the thought.
Other restrictions may include an expiration date or even a savings maximum. Plus there may be a monthly or annual maximum amount attached to the card. Some manufacturers restrict the maximum number of times you can use the card.
Various states also have regulations regarding its use. For example if a drug has a generic, you may not be allowed to use your card.
It goes without saying, but I’ll say it anyway, ALWAYS read the terms and conditions very carefully. Above all else, surprises are not what you want to face at the pharmacy window.
Copay Cards Aren’t Loved By Everyone
As you might expect some people believe because these cards only cover non-generic brand name medications they keep the price artificially inflated. They say this raises the insurance costs.
There are a number of pharmacy benefit managers and insurers that oppose copay cards. Those entities refuse to count them towards your deductible. Or out-of-pocket maximum, for that matter. When they do this the cost is re-aligned back onto the patient. Subsequently, these actions raise the cost to the patient.
All cards are not created equal. Some are lax in the help department. They simply don’t do enough for the holder. These leave those patients only one remedy. They have to call the manufacturers and ask for direct reimbursement.
Whether you want to be a participant in the patient assistance program or get a copay card it is incumbent you understand the rules of the program. It is your responsibility to get your questions answered.
Don’t be shy.
Ask away and get the help you need. After all, a copay card might be the answer for your situation.
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