When you use GoodRx to pay for a prescription, you are choosing to pay without insurance. But you can ask your insurer to reimburse you or to apply your purchase against your deductible. Here’s how to apply a payment made with a GoodRx coupon to your insurance deductible.
Nearly half of Americans now have high-deductible health plans (HDHPs), which means many of us are exposed to high medication prices (at least until we reach our deductible). In many cases, paying for drugs with a GoodRx discount can be cheaper than paying with 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 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 towards your deductible. Frankly, it’s tough to get a straight answer on the rules. When we called several insurance companies to ask about their policies, 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’s worth trying. Here’s how:
Get your receipts together. Save everything!
Fill out your insurer’s prescription reimbursement form (see list below).
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 | Claims Department P.O. Box 52065 Phoenix, AZ 85072-2065 Fax: 401-404-6344 |
| 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, but some 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 help@goodrx.com or 1-855-446-4051.
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 the cash price rather than the insurance price for your medication. Payments with GoodRx are considered “out-of-network” expenses. Some insurers may reimburse you for this cost or 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 pay a copay (a set cost per prescription) or a coinsurance fee (a set percentage of the overall cost) to get your prescription. Sometimes a price on GoodRx can be cheaper than your copay, so be sure to compare prices!
What if my insurer says they 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 apply your payment against your deductible. We’ve found that these policies can vary depending on who you talk to. It’s worth following 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 for your drug was cheaper than what you would have paid using your insurance.
Why should I use GoodRx if it doesn’t go towards my deductible?
For many people with high-deductible health plans (HDHPs), health insurance is only really helpful in case of a serious health issue. Filling the occasional prescription is often not enough to reach the deductible threshold with these plans, so you do have to do your homework to save. 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.
