Will My Insurance Pay for GoodRx?

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How to apply a payment made with GoodRx to your insurance deductible

When you use GoodRx, you are choosing to pay without your insurance.

But you can ask your insurer to reimburse you or to apply your purchase against your deductible.

Here’s the deal.

Nearly half of Americans now have high deductible health plans – which means they’re often exposed to a high prices for their medications, at least until they reach their deductible maximum. They may find cheaper prices on GoodRx than what they’re being asked to pay for their drug through insurance.

So if you use a GoodRx discount to get a lower price, can you get paid back for this purchase from your insurance? And even if you don’t get reimbursed, will your insurance count your payment against your deductible as an out-of-pocket expense?

The answer, it turns out: It depends. Paying with a GoodRx coupon is considered an “out-of-network” purchase, and it’s up to the insurance company to decide if they’ll pay you back – or whether they’ll count it to your deductible. Frankly, it’s tough to get a straight answer on the rules. When we called several insurance companies to ask about their policy, we got different answers, even from the same company, depending on who we talked to.

So while we can’t promise you’ll get reimbursed, it can be worth trying. Here’s how:

  1. Get your receipts together – save everything!
  2. Fill out your insurer’s prescription reimbursement form (see list below)
  3. Mail (or fax) the form and your receipts (make copies for yourself!) to the address indicated
Insurer & form Address & fax
Aetna Aetna Pharmacy Management
PO Box 52444
Phoenix, AZ 85072-2444
FAX: 1-888-472-1128
Anthem Express Scripts
P.O. Box 14711 Lexington, KY 40512
BCBS Texas Prime Therapeutics (Commercial) PO Box 25136
Lehigh Valley, PA 18002-5136
Blue Shield CA Argus Health Systems, Inc.
P.O. Box 419019,
Dept 191
Kansas City, MO 64141
Cigna Cigna Pharmacy Service Center
P.O. Box 188053 Chattanooga, TN 37422-8053
CVSCaremark CVS/caremark
P.O. Box 52136
Phoenix, Arizona 85072-2136
Express Scripts Express Scripts
P.O. Box 14711 Lexington, KY 40512
HealthNet Health Net of California
C/O Caremark
PO Box 52136
Phoenix, AZ 85072-2136
Humana Humana Pharmacy Solutions
P.O. Box 14140
Lexington, KY 40512-4140
Fax: 866-754-5362
Kaiser OptumRx Claims Department
P.O. Box 29044
Hot Springs, AR 71903
Optum OptumRx
ATTN: Claims Department
P.O. Box 29077
Hot Springs, AR 71903
Oxford OptumRx Claims Department
P.O. Box 29077
Hot Springs, AR 71903
United Healthcare OptumRx Claims Department
P.O. Box 29044
Hot Springs, AR 71903

 

Again, policies vary from insurer to insurer, and some may not reimburse you for your payment. But they may apply your payment against your deductible. They may also contact you for more information.

Let us know what happens, or if you need help: reach us at 1-855-446-4051 or help@goodrx.com

FAQs about GoodRx and Insurance

Can I get reimbursed when I use a GoodRx coupon?
When you use a GoodRx coupon or discount, you’re choosing to pay cash, rather than using your insurance. This is known as an “out of network” expense, and some insurers may reimburse you for the cost, or may apply your payment against your deductible.

What is a deductible, anyway?

Many health insurance plans have a deductible – an amount of money you must pay out-of-pocket before your insurance coverage kicks in. Some plans have an overall deductible for all medical costs, while some have a separate deductible for prescription costs.

Once you meet your deductible, you may still have to make a co-payment (a set amount for each prescription) or pay a co-insurance fee (a set percentage of the overall cost) to get your prescription. Sometimes a price on GoodRx can be cheaper than your co-pay, so make sure to compare prices!

What if my insurer says it won’t reimburse me?

Every insurance company makes its own policy on how to handle out of network expenses, and some may decline to reimburse you or to apply your payment against your deductible. We’ve found that these policies can vary depending on who you talk to. So be sure to follow up!

What if my insurer asks why I didn’t pay with insurance?

Explain to your insurer that you chose to pay using GoodRx instead of your insurance because the price on GoodRx was cheaper than what you would have paid using your insurance (either the co-pay or if you were exposed to the deductible).

Why should I use GoodRx if it doesn’t go towards my deductible?

For many people with a high deductible, health insurance is really there for a catastrophe, like an injury or serious illness. You may not expect to reach your deductible in the course of a year, just by filling the occasional prescription. GoodRx also comes in handy if your insurer doesn’t cover your drug at all. In these cases, you’d be paying out-of-pocket anyway, and you can save money with GoodRx.

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