The buzz is undeniable: Cash Discount Card Programs are making waves in the healthcare landscape as they integrate into Pharmacy Benefit Manager (PBM) offerings. CVS and ESI have both announced Programs integrating the GoodRx price(1,2) the most popular discount card on the market. Optum has a similar program called Price Edge(3).
What is a Cash Discount Card?
Cash discount cards like Singlecare and GoodRx provide discounts on prescription medications at participating pharmacies. Historically, users present the discount card when filling a prescription, and the discount is applied to the medications retail price. HR Benefits professionals would get inquiries from their members for why these free discount cards have a lower price than the insurance they pay for. Patients were in a catch 22, wanting the cheaper price, but not using their insurance meant their out-of-pocket costs would not apply toward their deductible or Out of Pocket Maximum under their insurance plan.
That’s changing as PBMs have recently begun partnerships with the major discount card players to ensure the lower price applies for patients, and the out of pocket amount applies toward deductibles and Out of Pocket Maximums.
Understanding the PBMs’ Cash Discount Card Programs
PBMs’ Cash Discount Card Programs aim to provide plan members with discount card pricing as part of the prescription benefit program. The fundamental mechanism behind these programs involves identifying situations where the PBM's negotiated price with the pharmacy results in a higher out-of-pocket expense for the member compared to the pricing offered by a discount card. In such cases, the discount card steps in, ensuring that the member receives the more favorable pricing.
GoodRx negotiates better pricing than these powerful oligopolies?
The Synergistic Power of Scripta Insights
Scripta Insights, the only independent and unbiased Rx Navigator on the market, plays a pivotal role within this landscape. The platform offers an integrated solution which empowers members by displaying all available pricing, including the claims that process with the discount card price through one of these PBM programs, and pricing through Scripta’s partnership with Singlecare.
Scripta's innovative platform increases pricing transparency. When the discount card’s pricing integrates into the lower-of logic applied to prescription claims at the pharmacy as part of one of these new PBM integration programs, Scripta uses the plan sponsor’s claims data to display the lower priced option in a transparent and cost-effective way for members. This lower-of-logic pricing from the PBM’s discount card integration program finds its place in Scripta's member-friendly tools, thereby enhancing the value that Scripta Insights brings as an objective overlay to your PBM.
For these PBM programs, when the discount card price represents the most cost-effective option within the binary lower-of logic, the discount price is adopted, and the member's cost-sharing portion is credited toward their deductible and Out-of-Pocket Maximum (OOPM). This strategic integration by the PBMs not only reduces the financial burden on members but also addresses a common objection plan sponsors have regarding the necessity of discount cards alongside insurance coverage. Additionally, these PBM programs ensure that adherence data remains within the system, offering valuable insights for both PBMs and plan sponsors.
Empowering Members to Save More
Scripta Insights empowers plan members to make informed medication purchasing decisions by providing easy access to prescription pricing information.
Take for example, a member who has been prescribed Vyvanse and hasn’t yet met their deductible. This patient may be faced with a cost of $323 per month through their PBM plan, prior to meeting their deductible. Factor in the integration of GoodRx logic and this cost decreases to just $280 for the member. Scripta's app  takes it a step further, offering the member even more options to save by presenting alternative options such as generic alternatives, amphetamine-dextroamphetamine, and dextroamphetamine, which can cost as little as $24 or $50 per month.
These clinically appropriate options offer members the potential for significant monthly savings, showcasing the power of Scripta Insights in delivering cost transparency.
A Comprehensive Solution for Plan Sponsors and Members
Scripta Insights serves as a comprehensive solution that empowers members by revealing a clear view of various prescription savings options. Plus, the platform offers concierge support services to assist members in understanding and maximizing their savings options. Irrespective of the PBM or PBM programs, Scripta Insights seamlessly enhances the members ability to make informed decisions about medication costs.
By effectively complementing the capabilities of Cash Discount Card Programs, Scripta Insights ensures that plan sponsors and their members can realize significant advantages in terms of cost savings, transparency, and accessibility. The future of affordable medication is here, centered on informed decision-making and empowering members to navigate the complex landscape of healthcare expenses.
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