With the continued rise in cost for prescription medications, many patients and employers are turning to prescription cost comparison tools, such as GoodRx and Blink Health, to find their medications at the lowest cost. There are a few points that employers should know when recommending these tools for their insured employee population. Understanding the different tools available is important for both the employee and the employer.
- Cost comparison tools have made researching medications simple. Most of these tools are online search engines developed with the consumer in mind. They are easy to use on a computer or smartphone and use the patient’s location to determine the closest and most affordable medications.
- Patients are shown multiple different pricing points based on pre-negotiated rates from pharmacies in their area. Some of these available rates do require a coupon, which can be printed directly from the website.
- These tools are not just for pricing, but education as well. Consumers can also research drug facts and potential side effects or drug interactions, lower cost alternatives, and manufacturer assistance programs.
Not All Good News
- Pricing found through prescription cost comparison tools and the negotiated pharmacy benefit coverage offered by an employer are mutually exclusive—meaning a member cannot use both benefits at the same time. If a member elects to use a coupon offered by a price comparison tool, the member is not allowed to submit the incurred expenses to their insurance, which means those expenses would not apply to any deductibles or out-of-pocket expenses.
- As of today, most of the third-party prescription cost comparison tools are unconnected to the PBM, therefore the PBM does not have a way
to track the data and link it to the current utilization. This could result in the member getting hurt through drug interactions. When a claim processes under the employee benefits, the pharmacy receives error messaging if the member has been prescribed a drug combination that has a drug interaction. This messaging process is extremely important, especially if the member has multiple providers who prescribe based on their specialty. Since the price comparison tool acts as its own insurance company, the drug interaction would not be triggered by the employee’s health insurance.
Some of these tools are offered as part of the PBM offering for self-funded plans. These programs are added on top of the plan’s pharmacy benefits to provide the employer’s negotiated retail discounts on prescriptions not covered by the plan’s pharmacy benefits. Members can research medications on their insurance patient portal either online or through the PBM’s app to find the lowest cost of the medication. The plan does not incur the additional expense, but since the program is offered by the PBM, the data is available for drug-drug interactions as well as tracking trends within the employee population. The member’s cost does not apply to their deductible or out-of-pocket since these claims are not covered by the plan. The downside of this offering is that it can cause confusion amongst the employee population as the seamless switch from the employee benefits to the savings card is done as soon as a claim is denied at the point of sale by the pharmacy benefit coverage. Members are often confused as to why a claim is “paying”, but they have to cover the full cost of the medication. Please discuss these tools with your account team today to understand the options available to you and the right approach for your population.