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Seen this type of meds coupon?
Posted by: Sarcany
Date: March 06, 2021 10:58PM
I visited the manufacturer's site for a prescription medication and found a coupon for it.

The coupon drops the co-pay on the meds to 1/5th that of my insurance company's co-pay.

The coupon requires that the pharmacy use the drug company as the insurer for the purpose of fulfilling the prescription, bypassing my own insurance company entirely. So, it's not so much a coupon really. In practice, it's some sort of fake-insurance thing.

What's the scam?

I know that drug companies use coupons to get people to use expensive name-brand meds and demand them from their insurance companies, thus greatly expanding the market for these meds and maintaining high prices, and as soon as they feel that they can exploit it they drop the coupons leaving patients on the hook for worse co-pays than they were originally avoiding.

But what's with this thing where they substitute for the insurance company? Are they doing it to collect personal info that would otherwise be protected by HIPAA?



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Re: Seen this type of meds coupon?
Posted by: TL
Date: March 07, 2021 12:41AM
It’s processed by your pharmacy for payment as a discount card funded by the manufacturer. The biggest reason it does not allow additional payment by your own insurance comes down to rebates, and pharma’s desire not to pay for a drug twice ( plus some issues with federal anti kickback statutes for certain plan types). Your insurance and the pharma industry have negotiated rebates for branded medications. Every fill of brand drug xyz nets your insurance plan some percent of the drug back in rebate. that rebate is typically used in aggregate to reduce plan premiums (it is for Medicare part d, probably to at least some extent for commercial plans).

As to why Pharma also pays, it’s not so much out of the goodness of their hearts. It’s a business write off. It’s product advertising. Note that these pharma-sponsored discounts are on branded products only, you don’t see on generics (except very rarely on certain generics during 6-month exclusivity period). They are also doing this to try to keep in the good graces if regulators.



Edited 1 time(s). Last edit at 03/07/2021 12:48AM by TL.
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Re: Seen this type of meds coupon?
Posted by: Sarcany
Date: March 07, 2021 09:53AM
Quote
TL
It’s processed by your pharmacy for payment as a discount card funded by the manufacturer.

It's not.

I confirmed this with the pharmacist. It is processed as insurance.



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Re: Seen this type of meds coupon?
Posted by: Ombligo
Date: March 07, 2021 10:09AM
One med that my wife was considering is $100/tablet and not on her insurance formulary (or medicare). If you go through the maker discount program the price becomes $1/tablet. The catch is in the fine print of the agreement. To get the reduced price, you give away all your HIPAA rights to Allergan Pharmaceuticals. It gives them full access to all your medical records, not just those related to this condition.

We decided to skip this med.



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Re: Seen this type of meds coupon?
Posted by: Sarcany
Date: March 07, 2021 09:02PM
Found this on one of the pages on their site:
Transaction information related to the [] Prescription Discount Program coupon will be shared with [] and any companies working on its behalf.

Pretty broad. Even if they aren't collecting other data, that's my private health data flying off anywhere in the world and subject only to the privacy and information-sharing policies of those other companies and of the companies that THEY do business with.



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