Drug Coupons Explained
We encourage and help anyone we can to obtain a coupon for their prescriptions.. We know, however, that there are emerging issues with them.
Drug manufacturers have some amazing but expensive medications. They have created coupon programs that help the consumer pay for the prescriptions up until that consumer reaches their insurance company deductible (most coupon programs require the consumer has insurance).
For the consumer, that appears to be fine. That is the good.
Once the member meets their deductible (even though they may not have actually paid that full amount, due to the coupon), the insurance company is hit with the cost. For the remainder of the year the carrier is paying the full cost on refills for that prescription. That is the bad (at least for the insurance company).
The battle between the manufacturer and insurance company is now heating up. The manufacturer wants to let the consumer off the hook for the cost (so they will use their product) but wants to get to the carrier reimbursement portion. Some insurance carriers have concluded that since the consumer did not actually pay for the prescription, deductible credit should only be given for what the consumer actually paid. We assume more carriers will follow suit.
We are beginning to see the consumer caught in the middle. The manufacturers do not want to keep filling the prescriptions for free. If they see that the member was not given deductible credit from the insurance carrier, the member is then billed for the full cost. The consumer assumes the coupon will work and does not find out it was rejected until after the prescription has been filled. The consumer then gets billed. And, that is the ugly.
We at BBG still see the coupon option to be worth researching and using. However, we are urging our clients’ employees and dependents to research this and reach out to us for help. We know a lot about these options and are learning how get ahead of being blindsided.