Others, inform customers that they will run the Prescription Discount Card, see what the price is, charge the patient that price, then reverse the claim. In a third scenario, pharmacies process Prescription Discount Cards, receive a bill from a Prescription Discount Card company, and simply did not pay the bill.
Each of these options has its risks. What pharmacies may not realize is that in certain scenarios they may be contractually obligated to accept and process Prescription Discount Cards through their Pharmacy Services Administration Organization PSAO.
Therefore, each time the pharmacy processes a Prescription Discount Card, it may be actually be costing the pharmacy money from other reimbursements that the pharmacy receives from the PSAO.
Moreover, the pharmacy may not be avoiding all these results by simply running the Prescription Discount Cards, charging the patient the reduced Prescription Discount Card price, then reversing the claim. First, particularly in instances where the transaction fee is being deducted from the general remittance from the PSAO, simply reversing the claim may not allow the pharmacy to escape the transactional fee.
As is the case in other areas such as E-Prescribing and claims adjudication with PBMs, transaction fees can be and often are charged regardless of the ultimate result of the transaction or if the transaction is reversed. Thus, reversing the claim may not always protect the pharmacy. Second, by undertaking this practice, the pharmacy may be subjecting itself to risk of audit by the PBMs. It is a wonder, therefore, why PSAOs would contract on behalf of their member pharmacies with Prescription Discount Card companies when Prescription Discount Cards result in high transaction fees, subject the pharmacies to additional liability with the PBMs, and are known to be a huge source of patient data mining.
They all mean the same thing. There are many players behind the scenes that make that discount off your prescription drug happen. All the cards generally work the same way, same process. Moreover, every card generally has some differences with discounts. The pharmacy benefits manager is a company that creates the program or works with a third party to do that and negotiates the discounts with the participating pharmacies. For example, Express Scripts a popular is a pharmacy benefits manager and works with the popular GoodRx prescription drug discount card.
Sometimes, a third-party or marketing group creates the program like GoodRx and contracts with the pharmacy benefits manager. The third-party marketing group then advertises and markets the card to consumers. Or, the pharmacy benefits manager creates the card program themselves and then works with outside marketing organizations to promote and advertise the card.
The Pharmacy Benefit Manager reaches out to pharmacies and signs them up to the plan. Certainly, every pharmacy will honor different discounts for different drugs. Many of the larger pharmacies participate in these card programs. However, many smaller and independent pharmacies may participate as well. Someone has to promote the card program, right? That is the job of the marketer. The marketer can be the company itself marketing the card program or independent brokers, agencies, and third-party marketing organizations.
It can also be non-profit associations and the like. However, it is much easier to view in an illustration. The pharmacy benefit manager or the marketing group develops the card program. Then, the pharmacy benefit manager negotiates drug discounts with pharmacies. The pharmacy benefit manager contracts with marketing groups and organizations to promote the program.
You receive mailings, see advertisements, and videos on social media about the card program. Drug discount cards are not a form of insurance. Drug discount cards are typically straightforward to use. Present the discount card at your pharmacy when you go to purchase your prescriptions. If you have insurance, the pharmacist can run your prescriptions with the discount card to see if the cost will be lower than your copay. If the cost is lower with the drug discount card than with your insurance, your pharmacist will use the discount card instead of insurance.
With the drug discount card, you may end up paying a lower cost than the retail cost or your copay. The best drug discount card is the one that helps you save the most money on most, if not all, of your prescription medications. You may need to research which cards will be the most beneficial for you.
There are some important factors to look for when looking for a drug discount card, such as the level of savings you would receive, where the card is accepted, and which medications the card covers. To see how much you can save with a discount card, simply search your medication on the card website.
If you go to InsideRx. You can choose to use a drug discount card instead of your insurance. Sometimes a drug discount card can save you more than your insurance. Then, the PBM negotiates with each pharmacy chain and all the participating local pharmacies to offer a discount on the drugs they dispense. The discount offered is usually a percentage of the cash price of the drug and the percentage may vary from drug to drug.
Next, the PBM finds companies or organizations in which to market their card. These groups, called marketers, may be for-profit companies or non-profit organizations. They may be multilevel marketing organizations and some marketers work with multiple groups. The amount you pay when using a drug discount card is the sum of four components. This is true for all drug discount cards. Some PBMs do a better job of this than others.
The size of the PBM, its market share, and how much business it will direct to the pharmacy are all important factors in the overall final discount. Pharmacy Transaction Fee — Each time a card is used the pharmacy earns a small amount to help cover their costs.
You may wonder why pharmacies accept drug discount cards. There are five reasons pharmacies accept the cards:. The pharmacy gets the sale, but earns a lower profit. Building customer loyalty — The drugstore business is very competitive. If a pharmacy gives you a good discount with a drug discount card you are more likely to continue to patronize that store than others.
This arrangement forces you to walk down aisles, increasing the chances you will make additional purchases. Peer pressure — If all the pharmacies in town but one accept drug discount cards, that one will lose business. There are two main ways card marketers make money from drug discount cards and items you should watch out for:. The size of the fee varies quite a bit.
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