Co-pay Cards FAQs
We are a non-profit organization that provides information on affordable drug programs, such as copay cards, to those who struggle to pay for monthly copays of expensive medications. As the cost of healthcare continues to rise, consumers need additional resources to help pay for their medications. Co-pay card programs are another option to consider. Typically offered by pharmaceutical companies, co-pay cards are designed to help people with private insurance for the co-payments required to obtain their prescriptions at the pharmacy. Each program is different, but many require a registration process prior to presenting the co-pay card to the pharmacist. The patient hands the co-pay card to the pharmacist when their prescription is being filled. The amount of the co-pay may be reduced or even covered entirely. If you're struggling to pay for an expensive medication, check out NeedyMeds.org to see if you qualify for a copay card.
Co-pay card programs offered by drug manufacturing companies are a direct way to lower out-of-pocket costs for prescription drugs for eligible patients. The cards can enable patients to afford the medications preferred by them and their physicians.
Patients with commercial/private insurance are eligible to enroll in the program. Co-pay cards are usually not need-based.
You can find co-pay programs on the NeedyMeds' website. They are offered either on our Coupons, Rebates & More page or under a Brand Name Drug Patient Assistance Program (PAP). You can also ask your doctor or check with your local pharmacy.
If you learned about the co-pay program on the NeedyMeds' website, follow the enrollment process. If your doctor has given you co-pay card information with your prescription, fill out the application and send it to the drug manufacturer.
Once enrolled in a co-pay card program, the patient provides his/her co-pay card and prescription to a pharmacy where the pharmacist enters the information into their system to submit a claim.
The pharmacist is required to enter the patient's insurance number in the primary field and an identifier from the co-pay card into the secondary insurer field. The patient is instantly provided with coverage data, relaying the patient's out of pocket costs, or co-pay to the secondary insurer's benefit manager, who then provides a discount accordingly. The pharmaceutical company pays for the program's cost, including the difference in the patient's cost.
The pharmacist is required to enter the patient's insurance number in the primary field and an identifier from the co-pay card into the secondary insurer field. The patient is instantly provided with coverage data, relaying the patient's out of pocket costs, or co-pay to the secondary insurer's benefit manager, who then provides a discount accordingly. The pharmaceutical company pays for the program's cost, including the difference in the patient's cost.
Yes. Co-pay cards are designed specifically to help with insurance co-payments.
Copay accumulator programs, also called Coupon Adjustment: Benefit Plan Protection Program, Out of Pocket Protection Program, and Specialty Copay Card Program, are programs that may limit the value of copay cards and discount coupons.
It's easiest to explain how these programs work with an example. Let's assume your insurance has a deductible of $4,000 and a coinsurance of 25%. This means you pay the first $4,000 of costs and then 25% of anything over $4,000.
You are prescribed a medicine that costs $1,000 per month and you have a copay card that covers the first $4,000 of cost. Your first month you pay nothing because the copay card covers your $1,000 bill. The same holds true for months 2, 3 and 4. So for the first four months you have no out-of-pocket costs.
In month five you go to pick up your medicine assuming the cost to you is $250 — your coinsurance of 25%. You figure you met your deductible with the copay card. The pharmacist says that you owe $1,000 because your insurance company has a copay accumulator program and didn't count the amount your copay card covered as going against your deductible amount.
With these programs the insurance companies collect your deductible twice — once from the pharma company that supports the copay card and then again from the patient who has to meet the deductible.
No. Any commercial/private insurance plan offering prescriptions may use eligible co-pay cards. Your eligibility depends on the terms of the specific brand co-pay card program and your insurance plan.
Co-pay cards may be used in local pharmacies and are also accepted by certain mail order pharmacies.
The duration of co-pay programs varies. The expiration depends on the parameters outlined by the pharmaceutical company providing the co-pay card.
Most co-pay card programs are designed for more expensive prescription drugs, but some other older or less expensive drugs have cards as well. It is best to check with your physician or pharmacist or on-line to see if your medication has a co-pay program.
Yes, they cannot be used with Medicare and Medicaid. Prescriptions eligible to be reimbursed, in whole or in part, by any federal or state healthcare programs cannot use co-pay cards.
Studies show that higher patient co-pay amounts are linked with fewer people taking their medication as directed, or reducing medication adherence. With a lower co-pay, consumers will be less likely to skip taking their mediation.
Co-pay cards help lessen patients' financial burden, making it more likely that individuals will fill their prescriptions. Offering co-pay cards for prescription medications provides patients and healthcare professionals with increased flexibility and choice to ensure the appropriate treatment option is chosen and attainable by the patient. In addition, some co-pay card programs offer educational material for patients, providing an opportunity for greater understanding of their condition and treatment.
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