Prescription discount programs — GoodRx, Mark Cuban's Cost Plus, and others

This article provides information about prescription discount programs. Always compare costs through your elder's insurance and various discount programs to find the best price. Consult with your pharmacist or doctor about whether using a discount program instead of insurance is the better financial choice for your situation.

There's something oddly backward about the medication pricing system in America. Your elder's insurance plan says the copay for their blood pressure medication is $45. A prescription discount program shows the price as $12. Which one should they use? The answer, frustratingly, isn't always obvious.

Prescription discount programs work differently from insurance. They're not insurance at all. Instead, they're negotiated relationships between discount programs and pharmacies. The pharmacy agrees to offer reduced prices for people using a particular discount program. Your elder gets a card or a code, presents it at the pharmacy, and pays the negotiated price. No insurance is involved. No claim is submitted. It's a simple cash transaction at a reduced rate.

This works in situations where the cash price through a discount program is lower than the insurance copay. Your elder's insurance might require a $45 copay for a medication. A discount program might offer it for $20. In that case, using the discount program saves money. The insurance is never involved.

GoodRx is probably the most well-known program. It's free to use and offers coupons that can be presented at participating pharmacies. You search for a medication and your ZIP code, see prices at different pharmacies, and get a coupon you can use at checkout. The pharmacy scans the coupon and gives a discount. No personal information is required. It's straightforward and transparent.

Mark Cuban's Cost Plus Drugs is a newer program that aims to reduce medication prices. It works slightly differently, with transparent pricing and a flat-fee model. Cost Plus drugs shows you the cost to manufacture, the overhead, and their markup, so you understand what you're paying.

There are other programs too. SingleCare and RxSaver operate similarly to GoodRx. Some pharmacy chains have their own discount programs. The picture of discount programs is constantly changing, which is why what worked last year might not be the best option this year.

Understanding when to use a discount program versus insurance requires doing the math. Talk to your pharmacist. Say you have insurance but heard there might be a cheaper price with a discount code. Ask them to price it both ways. They can tell you the insurance copay and what the price would be with a discount program. Sometimes insurance wins. Sometimes the discount program does.

There are some complications. Not all pharmacies participate in all discount programs. Your elder's regular pharmacy might not use GoodRx but might use SingleCare. This might require shopping around. Also, using a discount program typically means the insurance claim isn't submitted. This can affect deductible status and coverage information, though for most people this doesn't matter if they're just trying to save money on this one prescription.

Some insurance plans actually benefit from having discount codes used. If your elder has a high deductible and hasn't met it yet, using a discount program on inexpensive medications might save them money compared to paying a copay that counts toward the deductible. This is especially true for generic medications that are inexpensive anyway.

The other consideration is Medicare. People on Medicare Part D should generally use their insurance instead of discount programs, as using a discount program might affect their Medicare coverage and out-of-pocket tracking. This is complicated, and you'd want to talk to your elder's Medicare plan directly if this is their situation. A pharmacist can usually help clarify this as well.

For older adults without insurance, discount programs are genuinely helpful. Someone uninsured who needs a medication costing $200 can sometimes access it through a discount program for $40 or $50. It's not free like a patient assistance program, but it's dramatically cheaper than the full price.

Brand-name medications often have bigger discounts through discount programs than generic medications. That $200 medication might be available as a generic for $15, making the generic the better choice regardless of programs. Always ask about generics.

One mistake people make is assuming all discount programs charge the same rates. They don't. A medication might cost $15 through one program and $25 through another at the same pharmacy. This is why checking multiple programs sometimes makes sense, especially for expensive medications.

Another consideration is that not all medications are available through discount programs at discounted prices. Newer, more expensive, or niche medications might not have good discounts available. In those cases, patient assistance programs, insurance, or other options become necessary.

The privacy aspect worth considering is that some discount programs collect data about your elder's prescriptions. They might use this information for marketing purposes. If your elder is concerned about privacy, discuss this with them. Some programs are better than others regarding data protection. Reading privacy policies matters if this is a concern.

Using discount programs is generally safe and legal. Your pharmacist processes them like any other transaction. The medication itself is legitimate and comes from the same pharmacy supply chain as insured prescriptions. There's no quality difference. The only difference is the price paid and who processes the transaction.

For someone on a tight budget, knowing about discount programs can be genuinely lifesaving. A medication your elder couldn't afford through insurance might become affordable through a discount program. But this only helps if you know to check. Most pharmacists will help if you ask, but you have to ask.

The simplest approach is to have a conversation with your elder's pharmacist at each fill. Say: I want to make sure we're getting the best price. What's the price with insurance, and what would the price be with a discount program like GoodRx? Then compare. It takes two minutes, and it often saves money.

Always talk to your elder's doctor or pharmacist before using a discount program instead of insurance. Understand how this affects their deductible, coverage status, and any other insurance considerations. For Medicare beneficiaries, consult with their Medicare plan before using discount programs.