Key takeaways:
Manufacturer copay savings cards can offset the price of prescription medications for consumers with commercial insurance. There may be limits on how much you can save in a month and/or year with a copay card.
Copay cards typically cover medications that are not available in a generic version.
People whose prescription medications are covered by a government-sponsored insurance program, such as Medicare, Medicaid, or Tricare, don’t qualify for manufacturer copay cards.
Save on related medications
High prices for medications are the main reason many people don’t fill their prescriptions at the pharmacy. Though, some people with commercial insurance turn to manufacturer copay savings cards to help offset some of the costs. These savings programs, which come directly from pharmaceutical manufacturers, can reduce out-of-pocket costs for people who need help paying for brand-name medications.
Copay cards have faced criticism for steering consumers to higher-cost, brand-name medications, even when lower-cost, generic options are available. Insurance companies contend that the copay cards drive up their costs, which increases premiums for all enrollees.
Here’s everything you need to know about manufacturer copay cards.
What are copay cards?
Manufacturer copay savings cards can help consumers save on medications by lowering out-of-pocket costs. They’re also known as:
Copay cards
Copay assistance cards
Copay coupons
Copay savings programs
Copay cards are often offered for costly, brand-name medications that don’t have a generic equivalent on the market. Depending on the copay card program design, you could pay a nominal amount for your medication before meeting your deductible.
How do copay cards work?
The idea behind copay cards is to reduce commercially insured consumers’ out-of-pocket costs for eligible prescription medications.
When you use a copay card, your health insurance may pay some of the cost of the medication, while the manufacturer pays part or all of your share of expenses. In this case, the manufacturer pays a portion of the costs you’re responsible for through your copay or coinsurance. If your prescription plan doesn’t cover the medication, the manufacturer will cover all or some of the costs.
How do I get a copay card?
Copay cards are usually accessed through medication or manufacturer websites. You can also ask your healthcare professional or pharmacist about copay cards for your medications.
What are patient assistance programs? Patient assistance programs help people who are uninsured or underinsured and others having difficulty with healthcare expenses.
Get help affording your prescriptions. If you qualify, you can get aid paying for medications from programs offered by nonprofits, your state, and even medication manufacturers.
Why do medications get dropped from formularies? There are various reasons why an insurer may stop covering a prescription medication, including a less costly generic entering the market.
To sign up for a copay card, register online or call the program directly. Once you join, the manufacturer will usually provide a card to print out or save on your phone to bring with you to the pharmacy.
Are there any requirements or restrictions?
For most copay cards, there are two main requirements:
You must have commercial insurance.
You cannot have government-sponsored health insurance, such as Medicare or Medicaid.
A copay card typically has an expiration date and a savings maximum. This varies by medication, but there is typically a monthly or annual maximum. There are also sometimes restrictions on the number of times you can use the card.
For instance, the Gilead Advancing Access Co-pay Savings Program includes about a dozen medications. There are different annual cost-sharing limits for the medications. Some are subject to monthly savings maximums, while others aren’t.
Depending on where you live, there may be laws that restrict the use of certain copay cards. In 2017, California banned the use of manufacturer coupons to purchase brand-name medications that have generic equivalents.
When signing up for a copay card, be sure to carefully read the terms and conditions. You can always call the program if you have specific questions.
Are there concerns about copay cards?
Despite the savings, critics argue that copay cards actually increase costs in the long run. Relying on the cards can encourage people to stick with costly brand-name medications instead of switching to more affordable, generic versions, they point out. And manufacturers add costs to the healthcare system by shielding patients from expenses, which can raise prices for health plans.
There’s also the challenge of copay cards not working at the pharmacy. Consumers who have valid cards sometimes resort to paying their copay and asking manufacturers for direct reimbursement.
Copay adjustment programs
Pharmacy benefit managers and insurance companies have started crediting the discounts offered by copay cards in ways that ensure prescription plans get the most benefits from their use. These actions are known as copay adjustment programs and require consumers to have some out-of-pocket costs. Here’s how these programs are deployed:
Copay accumulator programs: By applying the copay maximums upfront until the value is exhausted, health plans derive some consumer out-of-pocket spending during the coverage year. With this type of program, plans also don’t credit the manufacturer copay assistance toward an enrollee’s annual deductible or, in many cases, out-of-pocket maximum so they remain on the hook financially.
Copay maximizer programs: With these programs, the annual maximum value of a copay card is applied evenly throughout the year. This may leave enrollees with little-to-no cost-sharring and allow plans to capture the most benefit possible from coupons.
Consumer advocates criticize copay adjustment programs as ways to circumvent a financial relief valve and warn that they could lead commercially insured people who take costly medications into medical debt.
How do I know if a copay card is available for my medication?
GoodRx will show you potential savings, including available copay cards, when you search for a medication on the website or app. You can also visit your medication or manufacturer’s website to explore potential copay card programs.
Frequently asked questions
A copay card could help you pay your deductible. You may receive enough copay assistance for your medication to meet your deductible, but only if your health plan credits the manufacturer’s contribution toward your out-of-pocket costs.
No, you cannot use a copay card if you don’t have insurance. Copay cards are specifically for people with commercial insurance plans. If you are uninsured, you should explore whether there’s a patient assistance program for your medication offered by the manufacturer or another organization.
The length of time you have access to copay assistance through a copay card depends on the manufacturer’s program. But most copay cards don’t expire for at least a year. Though, they typically have an annual cost-sharing limit.
A copay card could help you pay your deductible. You may receive enough copay assistance for your medication to meet your deductible, but only if your health plan credits the manufacturer’s contribution toward your out-of-pocket costs.
No, you cannot use a copay card if you don’t have insurance. Copay cards are specifically for people with commercial insurance plans. If you are uninsured, you should explore whether there’s a patient assistance program for your medication offered by the manufacturer or another organization.
The length of time you have access to copay assistance through a copay card depends on the manufacturer’s program. But most copay cards don’t expire for at least a year. Though, they typically have an annual cost-sharing limit.
The bottom line
Copay cards are offered by manufacturers to offset your out-of-pocket costs for brand-name medications. They often cover medications that do not come in a generic form.
There are requirements for getting a copay card, and there are usually limits on how much you can save in a month or year. Depending on how your insurer calculates the copay assistance, it may not be credited toward your deductible or out-of-pocket maximum. And you may have more out-of-pocket costs than you anticipate if your prescription plan uses a copay adjustment program.
Why trust our experts?
References
Allen, S. (2017). Prescription drug coupons actually increase healthcare spending by billions. Kellogg Insight.
Andrews, M. (2018). Why some patients getting drugmakers’ help are paying more. NPR.
Cavalier, D., et al. (2023). Patient perceptions of copay card utilization and policies. Journal of Market Access & Health.
Gilead. (n.d.). The Gilead Advancing Access Co-pay Savings Program.
Long, M., et al. (2024). Copay adjustment programs: What are they and what do they mean for consumers? KFF.
Rome, B. N., et al. (2021). Association of California’s prescription drug coupon ban with generic drug use. JAMA.
Tribble, S. J. (2018). For the asking, a check is in the mail to help pay for costly drugs. KFF Health News.
