Insured? GoodRx can still help you save. We've tried to answer the most common questions about using GoodRx in conjunction with your prescription insurance.
Can I still use GoodRx if I have health insurance?
If you have insurance or Medicare, GoodRx can still help you control your prescription drug costs and find prices that are lower than your typical co-pay.
You can use a GoodRx discount instead of your prescription insurance if the cost is lower. Our coupons can't be used with insurance or to lower your co-pay.
You may want to contact your insurance company to find out if you can submit receipts for prescriptions purchased using GoodRx. Many insurance plans will allow you to submit receipts for potential reimbursement and/or credit towards your deductible and other policy limits.
If you don't already know your co-pay, you can often use your insurance's web portal to look up what you will pay for a prescription.
How can GoodRx help me save if I'm already insured?
Typically, health insurance provides you with 2 benefits:
- A discounted price for your medications
- A set co-pay (often $10) for your medications
Here are 3 things to consider when deciding to fill your prescription with your insurance:
Is this drug covered by your plan? If so, how much will it cost?
Insurance companies use “formularies” which list how much they will pay for a specific prescription. Formularies divide drugs into “tiers.” Tier 1 drugs may have a $10 co-pay, Tier 2 may be $20, and so on. For many brand name drugs, your plan may cover just a percentage of a negotiated price. Check your insurance company's website to see if they provide pricing. Drugs that are not “preferred” may cost you more through insurance than if you use a GoodRx coupon and pay cash.
Have you satisfied your deductibles?
Many insurance plans have a separate prescription deductible you must hit before they'll pay for your medications, and other plans just have a high deductible for all of your care before they pay anything. In these cases, you'll usually still get a discounted rate, but it may not be as low as the prices GoodRx can find. Check your insurance company's website for more information.
Can GoodRx beat your co-pay?
Don't be surprised if local and mail order prices are well under your co-pay. The typical insurance plan in America offers a $10 co-pay for preferred drugs (and it goes up from there). Many, many generic drugs can be bought for less than $10. Why pay $10 when you could pay $4?
How do I use GoodRx instead of my health insurance?
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 to process the transaction instead. If your pharmacist has any trouble using the discount, ask that they call the phone number on the coupon—someone from the help line will be able to help them process it correctly and can answer any questions.
I have a high deductible plan. How can GoodRx help?
If you have a high deductible health plan (also known as an HDHP), you'll be paying out of pocket for most prescriptions and medical services until you hit a $1,000+ deductible. Plans vary, but deductibles for 2015 range from $1,300 – $6,450 for an individual and $2,600 – $12,900 for a family. If you're reasonably healthy, odds are high that you won't satisfy your deductible and receive co-pay benefits in the course of a typical year.
For prescriptions, using your insurance may get you a lower price than just paying cash at the pharmacy, but it'll generally be more than a typical co-pay, especially for brand-name drugs.
How can GoodRx help? Here's the good news. Cash and coupon prices are often lower than insurance co-pays.
Some generics are available under $5 or even free for a 30-day supply. For expensive brand name drugs, your plan's price may not be as low as the prices GoodRx can find, especially if the drug isn't on your plan's formulary. In addition, GoodRx offers all sorts of other discounts and savings tips. It always pays to shop around.
If you use GoodRx instead of your health insurance, just ask ask the pharmacist to use the coupon or discount card to process the transaction instead of your insurance.
Keep in mind though—the cost of prescriptions not purchased on your plan will not count toward your deductible. If you've had other medical expenses or if you have several pricey prescriptions, it may still be worth your while to use your insurance to satisfy your deductible.
How will the Affordable Care Act (Obamacare) affect me? Will GoodRx still be able to help?
If your plan is changing, you may have higher co-pays (you may pay a higher flat payment or percentage per prescription) or a higher deductible (you may have to pay more overall before your insurance starts covering your prescriptions). Some drugs that were covered under your old plan may no longer be covered, or may be more expensive. Otherwise, plans purchased on the exchanges and private insurance plans will continue to work in much the same way when it comes to prescription coverage.
GoodRx can still help, and you can still choose to use a coupon or discount card if the price is lower than your co-pay. Just ask that your pharmacist run your prescription with the coupon or discount card instead of using your insurance to get the lower price.
It is important to note that prescriptions purchased using GoodRx discounts instead of using your insurance will not count towards your deductible.
I have Medicare Part D / Medicare Advantage. How can I use GoodRx?
Even if you have Medicare prescription coverage, your Medicare co-pay 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 still help you control your prescription drug costs and find prices that are lower than your typical co-pay.
Using a Discount
You can use a GoodRx discount instead of Medicare if the cost is lower, but our coupons can't be used with Medicare or to lower your co-pay. It's also worth noting that any prescriptions not covered by Medicare won't count toward your deductible or toward getting you out of the donut hole.
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 to process the transaction instead.
Look for the ability to add your 2014 Medicare plan to your account on GoodRx this spring. We'll tell you your co-pay, 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, and let you compare your co-pay with our prices on the same page.
For now, you can use Medicare.gov to look up your plan and co-pay.