Co-Pay Card Programs

Making sure that patients have access to affordable, high-quality health care, including prescription medicines, is vital for the health of the U.S. population. Patients are sensitive to medication costs and some will avoid using medication if out-of-pocket costs are too high. Co-pay card programs offered by bio-pharmaceutical companies are a direct way to lower eligible patients’ out-of-pocket costs so they can afford the medications preferred by them and their physicians.

Preserving medication choice is critical to making health care accessible, effective, and affordable. Co-pay programs can help physicians make prescribing decisions based primarily on clinical outcomes since patient financial barriers are addressed.

Listed below are some of the most frequently asked questions about co-pay card programs.

FAQ

What are prescription drug co-pay cards?

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.

Who is eligible to enroll in co-pay card programs?

Patients with commercial/private insurance are eligible to enroll in the program. Co-pay cards are usually not need-based.

Where do I learn about co-pay card programs?

Ask your doctor or check with your local pharmacy. You can also check your medication’s Web site or visit patient assistance sites such as www.NeedyMeds.org.

How do I enroll?

It’s easy. If your doctor has given you co-pay card information with your prescription, fill out the application and send it to the drug manufacturer. If you learned about the program on-line, follow the enrollment process.

How do I ‘redeem’ a co-pay card?

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.

Can co-pay cards be used with insurance?

Yes. Co-pay cards are designed specifically to help with insurance co-payments.

Do I need to have a particular type of healthcare/insurance plan to be eligible for co-pay cards?

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.

Where can co-pay cards be used?

Co-pay cards may be used in local pharmacies and are also accepted by certain mail order pharmacies.

What is the duration of co-pay card programs?

The duration of co-pay programs varies. The expiration depends on the parameters outlined by the pharmaceutical company providing the co-pay card.

What prescription drugs are offered with co-pay cards?

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.

Are there any restrictions on the use of co-pay cards?

Yes; they cannot be used with Medicare and Medicaid. Prescriptions eligible to be reimbursed, in whole or in part, by any federal or state health care programs cannot use co-pay cards.

Do co-pay cards increase patient compliance?

By helping patients better afford the medicines prescribed by their doctors, co-pay programs improve adherence, particularly among elderly and lower income patients. They also reduce costs arising from patient non-adherence, such as emergency room visits and hospitalizations.

How do patients and healthcare professionals benefit from co-pay card programs?

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 their condition and treatment.