Should You Ever Use a Discount Coupon for Prescriptions if You Have Insurance?

If you have health insurance, you might assume that it will always give you the best price on your medications. However, there are often situations when using a Rx discount coupon will cost less than using insurance.

This doesn’t make sense to many consumers. Why would you ever pay more with insurance? To answer that question, you need to understand all the factors that go into the price of a prescription medication.

How Drug Prices Are Determined

Determining the cost of a prescription starts at the manufacturer level. Drug makers create a new medication or a new brand of an existing drug and set a list price for it. There are no regulations that limit the pricing of prescriptions, so it can vary widely. A new drug usually has a high price because it’s the first and only treatment for a specific condition. If there are already competing drugs on the market, this tends to drive the price down.

Pharmacy Benefit Managers

Consumers don’t purchase drugs directly from the manufacturer; they go to a pharmacy. Most people don’t realize, however, that there is a middleman in between the pharmacy and drug manufacturers. A company called a Pharmacy Benefit Manager (PBM) negotiates between manufacturers, pharmacies, and health insurance companies.

Pharmacy Benefit Managers play an important role. They can often negotiate lower drug costs for pharmacies. They also help insurance companies determine which drugs will be covered. We encourage consumers to compare the costs of their medications. In some instances, insurance may provide you with a better price than a prescription discount card or coupon. On the other hand, don't assume that your insurance will always have the best available price.

Gag Clauses

Pharmacists know when insurers prices are higher than using a discount card. But they may not be able to volunteer this information due to a clause in their contracts. This is commonly referred to as a gag clause.

Many states have passed laws banning gag clauses. But even if your state has not banned them, you can still get around the clause by just asking the pharmacist about the AmericasPharmacy.com price. They are usually able to tell you if you ask directly.

Insurance Formularies

The last factor of drug pricing is your insurance formulary (the list of drugs covered by your plan). Drugs are organized by tiers on a formulary. The tier determines the co-pay amount. Drugs at Tier 1 are usually the cheapest, while Tier 3 and Tier 4 medications are the most expensive.

Now that you know about all the complex factors that go into drug pricing, you may be wondering what you can do about it as a consumer. The simple answer is to always ask the pharmacist what your medication would cost you by paying with an Rx discount coupon, even if you have insurance.

Do You Have to Use Your Insurance for Prescriptions?

A common misconception is that you must use your insurance every time you fill a prescription. You can actually choose whether to use your insurance or pay using an Rx discount coupon. In some cases, you can get a better price using an Rx discount coupon.

So Is It Better to Use an Rx Discount Coupon or Health Insurance?

There is no straightforward answer to the question of whether using an Rx discount coupon or using insurance is better. This varies on a case-by-case basis. Some drugs that are covered by your plan may be available at a greatly discounted co-pay amount. Others may be more expensive with insurance. That’s why it’s important to always ask the discount coupon price when you fill an Rx.

You can also figure out the cost ahead of time. Compare drug costs at local pharmacies with the America’s Pharmacy drug lookup tool. Once you find the best price, print the coupon or show it to your pharmacist from your phone to receive that price.