Using GoodRx and Health Insurance: Proceed with Caution
Imagine you are a middle-class earner with a high deductible health plan. You have been prescribed a medication by your physician to later find out at the pharmacy that it will cost you over $200 to fill the prescription. If you live in the United States, this may very well be a situation you have run into. 58% of companies with 200 or more employees have a consumer-driven health plan with a deductible of $1500 or greater. Along with this, the average point-of-sale price for prescriptions has risen 25% between the years of 2013 and 2017. With the rising cost of prescriptions and deductibles, consumers are looking to price comparison apps, such as GoodRx, to save money on prescriptions.
What is GoodRx?
GoodRx is a user-friendly app which allows consumers to shop and compare the prices of prescriptions. Through the app, consumers can gain access to coupons and find out which prescriptions have generic options.
How does GoodRx work?
Users can go to GoodRx.com or download the app, type in the drug to find the lowest cost pharmacy, access coupons available, and view generic alternatives. Once the user finds the best price, they can show their phone to the pharmacy to receive the discounted pricing.
GoodRx has become a household name for pharmacy savings. They were recently ranked №6 on the 2019 CNBC Disruptor 50 List, claiming to of saved American consumers $10 billion on prescriptions. It’s common for me to go into an open enrollment meeting and have employees ask about the tool. Though the company has done the good work of making drug transparency mainstream, there are areas of caution many consumers aren’t aware of until they attempt to use the application or view their claims after using a GoodRx provided coupon. Here is a list of examples of when it’s a bad and good time to use the cost-savings tool.
You should not use GoodRx when….
Your health plan covers your medication at a lower price than GoodRx. If you are under an employer-sponsored health plan, or you have elected coverage through healthcare.gov, your health plan will generally include a prescription benefit. What’s not well-advertised on the GoodRx website is that you cannot use a GoodRx coupon and have the cost of the prescription allocated towards your deductible. Look at the cost of Naratriptan, a drug which treats migraines. Through GoodRx I will get the price of $31.45, however, if I use my health plan, I will get the drug at no cost. In this instance, it would not make sense to shop around and use GoodRx.
You will easily meet your deductible. If you are on a consumer-driven health plan (CDHP) with an HSA, prescriptions are covered at a copay once you hit your deductible. If ongoing care and the cost of your prescriptions will get you to your deductible quickly, without using the GoodRx prices, consider doing this. You will have to compare the total cost of meeting the deductible + out of pocket costs (copays and coinsurance) vs the savings with GoodRx.
You qualify for a patient assistance program. Many high-cost prescriptions have an assistance program to help consumers receive the drug at little to no cost if you qualify based on your level of insurance coverage, household income, and out-of-pocket medical expenses. These savings do not count towards your deductible, however, they may provide more savings than GoodRx.
You should use GoodRx when….
You don’t have health insurance. If you are not enrolled in a health insurance plan, GoodRx is a great tool to pay a discounted price for prescriptions. The price you see on the GoodRx app is the cash price you can pay for the prescription. For specialty pharmacy, the prescription will still likely be unaffordable. For these, I recommend going to the pharmaceutical company’s website to apply for their patient assistance program.
You are on a CDHP with an HSA and you won’t meet your deductible. The average health plan deductible is $1500 for individuals. On a CDHP, you will generally have to meet your deductible before prescriptions are covered. If you are taking a prescription which offers a discounted price through GoodRx which is less than you would pay using your insurance, and you do not expect to meet your deductible, then using the GoodRx price might make sense for you. Consider you will pay $15.75 using GoodRx for the drug Divalproex which is used to prevent seizures for patients with epilepsy. Through your plan, the drug costs you $26.01 each month. If you do not think you will meet your deductible with other health care expenses, it would make sense to receive the discounted price and not submit the prescription claim to your insurance.
You are in a short term health plan. Many short term health plans do not include prescription coverage. Short term health plans do not have to abide by ACA guidelines and with pharmacy being a high-cost expense, the carriers can keep the premium low by leaving pharmacy out of the policy. If you are currently enrolled in this type of health plan you may benefit from the cash prices on GoodRx.
GoodRx certainly has its place in the healthcare market. They have brought light to the lack of transparency within the pharmaceutical industry and they have given some control back to consumers.
The Hard Truth: GoodRx is paid by the same industry they are disrupting. They receive revenue from pharmacy benefit managers (PBM) just as the insurance carriers do. Essentially GoodRx has cut out one middle man in the prescription buying process and inserted themselves as an alternative, none of which actually impacts the unfair price gouging of the pharmacy industry. The savings may make sense in the short term for a consumer, however, we will continue to face unaffordable prescriptions until the light is shined on the unfair practices within the entire pharmaceutical ecosystem.
Jessica Du Bois is an Employee Benefits & Healthcare Consultant in the Washington DC region. Jessica helps companies reinvent their benefits program by creating an enjoyable user experience and implementing cost- containment strategies. Check out more at https://jessicadubois.co or reach out to her at jessica.dubois@bbgbroker.com.
