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Key takeaways
Manufacturer copay cards, funded by drug manufacturers, help insured individuals afford expensive brand-name medications by lowering out-of-pocket costs.
Copay cards are typically for brand-name drugs without generic equivalents and are not available to uninsured individuals or those with government insurance due to federal anti-kickback laws.
To obtain a copay card, individuals can contact the drug manufacturer directly, consult healthcare providers, or use resources like needymeds.org, but eligibility and savings vary based on specific terms and insurance.
While copay cards can significantly reduce the cost of expensive medications, making them more accessible to patients, they are most beneficial when no generic alternative is available.
Inflation is driving up the cost of living in the United States, and prescription prices are no exception. Perhaps more than ever, affordability is an important factor for physicians to consider when prescribing medications to their patients. When available, generic medications can help to reduce the cost of medications for many health conditions. But what if no generic exists, and you have to use an expensive brand-name drug to manage your condition? Manufacturer copay cards are one way you can save on pricey medications. Here’s what you need to know.
What are copay cards?
Many people give up on brand-name medicines they need because their insurance doesn’t cover the cost, says Wendi D. Jones, Pharm.D., a pharmacist for Aspen RxHealth. Manufacturer copay cards, also called copay coupons, are funded by a drug’s manufacturer to help insured individuals afford expensive prescription medications by lowering out-of-pocket costs. Copay cards are typically for brand-name medications that do not have a generic, low-cost equivalent.
Copay cards are available to individuals with a commercial insurance plan. Many manufacturers have such programs to help make brand-name meds more affordable, says Dr. Jones. Designed to help cover the cost that remains after your insurance plan kicks in, copay card payments can sometimes count toward your deductible, but it depends on your specific plan.
But individuals who are uninsured or who have government insurance, such as Medicare or Medicaid, aren’t eligible for copay cards, says Stella Bard, MD, a board-certified rheumatologist in Brooklyn, New York. That’s because of the federal anti-kickback law, which made it illegal for manufacturers to pay for items that are reimbursed by government insurance plans.
For individuals with Medicare or Medicaid, Dr. Bard recommends Patient Assistant Programs (PAPs) as an alternative. PAPs are sponsored by drug manufacturers, nonprofits, and government agencies to help people who are uninsured or underinsured get free or discounted medications; eligibility for these programs is based on income.
How to get a copay card
Where to find copay programs
The best way to find copay cards is directly from the manufacturer of the drug, or from your healthcare provider or pharmacist. Your prescriber might have pamphlets that contain information about copay cards, so if you are unable to find information online or don’t have access to the internet, you can contact the manufacturer by phone. You can also use the non-profit site needymeds.org to search for your medicine and find the manufacturer‘s contact info.
How to enroll
While they can help customers save, copay cards do come with restrictions. For example, the amount covered by a copay card may or may not affect your insurance deductible and out-of-pocket maximums.
The duration of a copay program will vary depending on the drug manufacturer, and eligibility is based on the terms outlined by the manufacturer as well as your insurance plan. What’s more, copay card information is specific to the drug and manufacturer, and some require patients to fill out an application to qualify, so be sure to check out the terms and conditions.
The savings can be big with these types of discounts. For example, you can find a copay card for the brand-name diabetes drug Januvia, which retails for $718 for 30, 25 mg tablets on average, for as little as $5 on its website. The coupon may be used once every 30 days by residents of the U.S. and Puerto Rico, with a maximum savings of $150 per prescription.
Where to redeem a copay card
Copay cards can be used at any pharmacy that accepts commercial or private insurance providers, both in person and online. To use a copay card, simply present it to a pharmacy staff member along with your prescription and insurance information in order to process a claim. If you’re using a mail-order pharmacy, follow the instructions on the pharmacy’s website.
The bottom line — When to use copay cards
If there’s a less-expensive, generic medication available, it may be a better option than using a manufacturer copay card. However, there’s no downside to patients saving money on expensive brand-name prescriptions with copay cards. After all, being able to afford your medication makes it more likely that you’ll take it as intended by your provider, and adherence is vital when managing chronic conditions.
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- Download our iOS or Android app or go to our website.
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When you go to the pharmacy, show your pharmacist the coupon to save!