What to know about manufacturer copay cards

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The out-of-pocket costs of prescription medications have risen over time. Out-of-pocket costs are costs that insurance does not cover.

In recent years, the United States has experienced 25% higher cost sharing for prescription medication. Around 20% of people have reported that they believe the out-of-pocket costs are unreasonable.

Manufacturer copay cards may help offset these costs by offering financial assistance in the form of copayment. The copay card is a coupon that a person can use at a pharmacy to cover part or all of the out-of-pocket cost of a prescription medication.

The medication manufacturers provide the copay cards and determine the maximum amount they will cover for each medication individually.

A person may use the cards to help lower the costs of more expensive brand-name drugs but not generic alternatives.

When a person uses a copay card at a pharmacy, the medication manufacturer that has provided the card will cover part or all of the cost of the medication.

A person can only use a copay card for the brand-name prescription medication the manufacturer has specified, not for generic alternatives.

Copay cards may also have maximum savings allowances and restrictions that limit the number of times someone can use them.

People can access copay cards through the medication manufacturer’s websites. They can check their eligibility, inquire about more information, and register.

A pharmacist or healthcare professional may also be able to provide information about manufacturer copay programs.

Copay cards are not available for all prescription medications. Manufacturers will only provide them to people with prescriptions for specific medications.

To determine if a copay card is available for their medication, a person can try:

• asking the healthcare professional who prescribed the medication or a pharmacist
• visiting the manufacturer of the medication’s website and searching for information on copay cards or coupons
• calling the manufacturer of the medication to inquire about financial assistance options
• using tools on websites such as needymeds.org, which has a database that includes information on which manufacturers offer copay cards

The eligibility requirements for a copay card may vary between manufacturers.

Typically, copay cards are only available to people with private health insurance and those without government health insurance, such as Medicare or Medicaid.

Restrictions

Some restrictions may prohibit a person from getting or using a copay card. These include:

• Having government health insurance: A person cannot get a copay card if they have government health insurance, such as Medicare or Medicaid. This is due to anti-kickback statutes preventing manufacturers from persuading people to buy certain products or services by offering to cover costs when the federal government may reimburse those costs.
• Location-specific restrictions: Some areas may have laws restricting the use of copay cards. For example, California does not allow people to use them to cover the costs of brand-name medications if generic versions are available.

Critics of copay cards argue that the savings programs may drive up health system costs and lead to higher costs over time.

Some believe that copay cards may lead to an increase in the demand for expensive drugs and could encourage the misuse or overuse of certain medications. Copay programs may lead to higher costs for insurers, who may have to take on greater expenses.

While more research is necessary, some studies have found that copay cards can help reduce the financial burden of out-of-pocket costs for individuals. They may also help people continue taking their medication as doctors have prescribed.

Research also found that copay cards did not affect demand for specific medications in a large health system and were especially helpful when no generic alternatives were available.

Do copay cards count toward deductibles?

A person needs to review the terms and conditions of their insurance provider to determine if the copay card payments count toward deductibles.

Some copay card payments may count toward deductibles, while some insurance plans contain features that prevent a manufacturer’s payment from counting toward them.

What is the difference between a copay card and a discount card?

The manufacturer of a medication provides a copay card to offset the out-of-pocket cost of specific medications. A person can use them alongside private insurance.

Third-party companies that negotiate lower rates with participating pharmacies offer discount cards. Discount cards apply to various prescription medications, including generic alternatives, and are not limited to specific manufacturers. A person can use discount cards instead of private insurance.

Why do copay cards exist?

Manufacturers provide copay cards to offset the out-of-pocket costs of some medications they produce.

Aside from providing financial assistance to individuals, copay cards can help manufacturers drive sales of their products, especially for new medications.

Medication manufacturers offer copay cards to offset the out-of-pocket expenses of some prescription, brand-name medications. The manufacturers agree to cover part or all of the cost of the medication.

To receive a copay card, a person typically has to meet certain eligibility requirements, such as having private health insurance. Copay cards are unavailable for all brand-name medications and do not apply to generic medications.

Manufacturers usually restrict how often a person can use their copay card and how much they will cover.