5 Ways To Beat Your Insurance Copay

medical bag next to money
Elizabeth Davis
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“I don’t need to worry about drug prices. I have insurance!”

 

At GoodRx, we hear people say this all the time. After all, isn’t that what health insurance is for? You pay your premium and then insurance pays for your medical bills. Right?

If you use GoodRx, you probably already know that prescription drug insurance isn’t what it used to be. Not long ago, most Americans had generous prescription benefits as part of their insurance. You probably remember $10 copays and never being shocked at the pharmacy counter.

 

 

So, what’s changed? In general, health insurance is simply paying for less than it used to. The cost of healthcare has gone up, payors (whether the insurance company, your employer, or even the government) need to control their costs and they shuffle that cost to you, the patient, in different ways. As a consumer, you need to watch out for these “features” of your insurance policy, all of which could cost you at the pharmacy counter:

 

 

Wait—here’s the good news! Cash and coupon prices are often lower than insurance copays, and GoodRx is an easy way to make sure you’re getting the lowest price out there, whether you have insurance or you’re paying out of pocket. These tips will help you beat your insurance copay.

 

1) Get to know your insurance prices.

Health insurance will offer either a discounted co-insurance price on your prescriptions, or a set copay (often starting at $10).When you’re deciding whether to fill with your insurance, find out 1) whether the drug is covered by your plan and 2) how much it will cost.

Remember, your formulary lists the drugs your plan will cover and tiers will ultimately determine your copay or co-insurance. If you don’t already know your copay or co-insurance for your prescription, you can often use your insurance’s web portal to look up what you will pay—or you can give them a call to get an estimate.

Even better, if you have Medicare Part D, you can find your copay, as well as the prices you’ll pay until you meet your deductible, while you’re in the donut hole, and after you leave the donut hole all on GoodRx.com. Just add your Medicare plan after searching for a drug on GoodRx.com to see prices.

 

2) Research discount prices.

Some drugs may cost you more with insurance than if you use a coupon and pay cash. The typical insurance plan in America offers a $10 copay for preferred drugs (and it goes up from there). Many generic drugs can be bought for less than $10. Why pay $10 when you could pay $4?

For example, if you take metformin for diabetes, your copay may be $10 for a 30-day supply. What you may not know is that many pharmacies price metformin at $5 or less with a discount. And some, like Publix or Meijer, will even fill your prescription for free.

On GoodRx.com, you can compare cash prices, discount prices, pharmacy membership program rates, and prices at online and local pharmacies. GoodRx coupons are free and there are no obligations or hidden fees.

 

 

3) Yes, you can use a discount even if you have insurance.

Prescription discounts, including those from GoodRx, can be a great option if you don’t have health insurance, but if you do have insurance, you can always use a GoodRx discount instead of insurance if the cost is lower. Our coupons can’t be used to lower a copay, but you can ask your pharmacist to apply a coupon, use a pharmacy membership program or check the cash price instead.

What if I have Medicare Part D?

Just like with other types of insurance, you can still use GoodRx if you have Medicare Part D or Advantage. Your Medicare copay may not be the pharmacy’s lowest price, especially if you haven’t reached your deductible, are in the donut hole or are purchasing a drug that’s not on your formulary.

GoodRx can help you control your prescription drug costs and find prices that are lower than your typical copay. Compare your Medicare Part D copay with GoodRx discount prices on GoodRx.com by adding your Medicare plan after searching for any prescription.

How do I use a coupon at the pharmacy?

If you choose to use a GoodRx coupon or other discount program, just ask the pharmacist not to run your prescription through your insurance. (They do this all the time.) Ask that they use the coupon or discount card when they process the transaction instead. If your pharmacist has any trouble using the discount, ask them to call the phone number on the coupon for help processing or to answer any questions they might have.

 

4) Use GoodRx to contribute to your deductible.

If you purchase a medication with a GoodRx coupon and the drug is covered by your insurance, you may be able to submit your receipt to your insurer and count that towards your deductible. That way, you’ll still be able to take advantage of your insurance coverage later.

This applies to almost all types of insurance plans, including those from private insurers, commercial health exchanges, Medicare and Medicaid. You’ll want to contact your individual provider to find out what information they’ll need from you and how to submit it.

 

5) Need more than a coupon? GoodRx offers other ways to save.

GoodRx also provides information about other ways to save on prescription medications like savings tips to ask your doctor about, suggestions for alternative drugs that might be less expensive, information on manufacturer coupons and patient assistance programs, and much more. Our goal is to help you become an informed consumer by providing important information about drugs and drug savings in an easy-to-understand way.

 

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