Maintaining the status quo under the guise of “patient savings”

Above is one of the worst coupons I’ve ever come across. RxSaver is owned by GoodRx. Even at the surface level, this is an alarming coupon. Without diving into the details yet, RxSaver is essentially saying the value of a pharmacist’s drug utilization review (DUR), patient counseling, technician help, vials, label, and hydrochlorothiazide tablets (i.e. everything) are only worth $1.91. Unfortunately, it is actually worse. The following image describes the flow of money in this transaction (based on industry averages).

As you can see, the pharmacy is at a net $15.69 loss. Meanwhile, the PBM and GoodRx (coupon company) are the ones actually making money. Put differently, PBMs (and their coupon partners) have found a way to make money off of completely uninsured patients.

I recognize the goal of sharing these resources is patient-centered — to aid in medication accessibility. However, we cannot fight for properly valuing a pharmacist’s expertise and skills (and fight for a new and better system) while promoting a system that perpetuates the status quo. There are many ways to work within the current system to help with access without including unnecessary third parties. Some ideas include (I’ll continue thinking on it and share if any more come to mind):

• Find a pharmacy that is willing to price medications in a fair and transparent manner (start with independent pharmacies as they are most likely able to make such changes)
• Promotion of store coupon cards (generally don’t involve a PBM) AND/OR flat, NADAC-based coupon such as CapitalRx
• Referral to alternative community resources that may help patients most

Change is hard, but without discussions like these, much will remain the same.