A funny thing happened when picking up a prescription at my local Stop & Shop pharmacy. I asked the pharmacist to compare the price using my health insurance prescription drug plan versus the GoodRx price. GoodRx is a free discount drug service.
He said that GoodRx was less than my insurance. (This has happened before and it raises a whole other issue of how in the world when paying for prescription coverage can their price wind up being more expensive than the price with a free discount card?)
With the GoodRx number I had given the pharmacy years ago, the price came to $8.68.
I was a bit shocked because I had checked the price at the GoodRx website for this particular pharmacy, and it was almost double what the pharmacy actually charged using my old card.
*MOUSE PRINT:
The pharmacist said there was no rhyme or reason for the various prices charged or how it is possible that discount cards can offer better prices than real insurance coverage.
We asked GoodRx how a price using one of their old cards could differ so dramatically from their current website price at the same particular pharmacy. Here is what a spokesperson told us, in relevant part:
There are a few things that may have led to the discrepancy between the price with your prior, physical card and the price you see on our website:
Contracted reimbursement: Some of the prior pricing we distributed under our ‘PBM marketplace’ model, particularly via direct mail, were individually contracted between PBMs and pharmacies. While some of these legacy PBM cards may be accepted at point of sale based on their legacy agreements, and could have lower pricing and margins to retail, we want to make sure both our consumers and retail pharmacies have a sustainable and reliable experience at the counter.
We also checked with NeedyMeds.org, a nonprofit that connects consumers to affordable medication programs. Their president echoed GoodRx’s comments suggesting that the old card may have had a better pricing structure, and that reimbursement rates change online quickly and can vary among processors.
Whatever the reason for the difference, it pays to double-check the price if you have an old GoodRx card laying around or on file at your pharmacy. You could save money.
Just another example of how the whole system is broken.
Recently I was prescribed a medication that with Medicare RX coverage was 243.00. I went to the GOOD RX app and the cost was 86.00. When I got to CVS pharmacy, after asking to use GOOD RX coupon, a few minutes later I was told that CVS has a new program. The cost of the script was 74.00. Why did I have to ask and they not do this automatically AND why am I paying for Part D coverage and being penalized at the same time by Medicare for even having Part D coverage?
See Jason’s comment above.
You ever notice how, when you get a bill for a medical visit, your co-pay JUST HAPPENS to be the EXACT amount left over when they subtract what your insurance pays from the made up charge your provider bills??? GEE, WHAT A COINKYDINK! It’s all made up BS designed to milk us. Meanwhile, when my wife passed away on a plane enroute to Iceland, and was taken to a hospital there, I was billed NOTHING from the hospital. Try that here
You are looking at your own insurer’s payment/claim record, and of course they are not going to pay what your copay is. They pay everything but that.
That GoodRx explanation sounded just like the Abbott and Costello “Who’s on First” routine.
None of the reported pricing results makes much sense. Welcome to the American health care system.
But one thing to remember is that GoodRx is not subject to the standard federal health privacy rules known as HIPAA. In fact, GoodRx tells you that “As described in our Privacy Policy, we work with certain advertising partners to show ads that are targeted to your interests.”
Under HIPAA, selling health info to advertisers is prohibited without consent by your doctor, hospital, and health insurance company. If you are saving enough money, you may not care. Do you really want the great American marketing machine to know what drugs you take and your diagnoses?
I don’t want to go on too long, but here’s the list from the GoodRx website of those that they share your information with:
“We may share your information with the following service providers and third parties to perform services on our behalf such as:
Data warehouses, servers, and storage providers
Data analytic, data connectivity and customer data providers and platforms
Customer engagement or relationship management platforms
Advertising networks, advertising software tools, advertising servers, advertisers, sponsors and partners that market and advertise to you and measure performance of marketing and advertisements
Cloud computing providers
Survey and customer feedback providers and platforms
Printers
Mailing houses and delivery services
Data providers
Software development tools
Referral program platforms
Pharmacies, healthcare providers, pharmaceutical manufacturers, copay card providers, insurance plans and other entities in the healthcare ecosystem
Data providers, email delivery, and analytics software
Text delivery and analytics platform
Customer service software
Patient advocacy support providers to handle your requests
Privacy management platform, such as to manage deletion requests
Prepaid card and gift card vendor
Credit card and payment processors that process your credit card information (in cases where you provide us with your credit card information) and track payments
Information security, fraud detection and prevention providers
Identity and professional credential verification providers
Auditors, third parties conducting security assessments and services, law firms, staff augmentation firms and other professional services providers”
GoodRx pricing is the result of wheeling and dealing between multiple cogs in the machine. With so many factors influencing pricing, I’m not surprised that there are discrepancies.
I basically run all my prescriptions past GoodRX before paying for anything, and I barely ever use the prescription coverage included in my health insurance.
The whole pharmacy benefit manager system is a complicated mess.
I have used GoodRX in the past and was generally pleased with the savings. Then the pharmacist at my local Publix pharmacy told me they have a program that compares many different such cards and sometimes another card has a better price than GoodRx. But she also told me that the price can vary even on one day.
Which has more different prices: a medicine or an airline seat?
I always tell people to check the drug manufacturers website for discount programs. You usually have to have insurance to use these programs but if you have that, you can get huge savings.
For example, Ozempic is usually $349 to $499 per month. If you use their program, you can get a 90 day supply for $25. Many drug companies offer programs like this. it never hurts to check.
“How in the world when paying for prescription coverage can their price wind up being more expensive than the price with a free discount card?”
The insurance companies simply profit by making copays higher – sometimes much higher – than the actual cost of the drugs.
It’s worth checking multiple discount cards for every prescription. The pharmacies’ own discount programs are often worse than some of the others. Pharmacies have apparently started to offer their own programs in hopes that you won’t bother to check GoodRx et al. and they can charge you more.
In addition to NeedyMeds mentioned in the article, it’s worth checking the other discount cards listed at https://www.healthline.com/health/best-prescription-discounts.
For my most recent very expensive prescription, Optum Perks offered a better price than GoodRx.