In several recent posts during the past few years, I've addressed the emergence of prescription drug discount cards and apps. Perhaps the most notable post on that can be seen HERE.
Much of that began with the company known as GoodRx Holdings, Inc., but a downside to GoodRx is because it only has access to a single formulary (most PBM's typically merchandise a high-price/high-rebate formulary which benefits the PBM, as well as other formularies demanded by big clients which tend to favor lower cost generic drugs) offered by each PBM it does business with, that also means it may not have access to the other formularies which mainly preference generic drugs, hence GoodRx's prices on many generics, quite frankly, stink. That's when I discovered a work-around of sorts.
Using the PBM known as Express Scripts (now a wholly-owned business unit of the commercial healthcare insurance company Cigna, which the company refers to as its "Evernorth" business unit, perhaps because the PBM name had become kind of toxic and a different name helps investors realize that different management is now running the business) as an example, the Express Scripts formulary GoodRx has access to is quite evidently the largest formulary offered by Express Scripts which is called the Express Scripts' National Preferred Formulary (NPF). That is it's largest commercial formulary, with more than 28 million covered lives and that formulary tends to favor high-price/high-rebate drugs. Meanwhile, it offers a completely different formulary called the Express Scripts' National Preferred Flex Formulary, tends to favor drugs with lower list prices (generics) over the high-list/high-rebate versions of drugs, and the Flex formulary is notably excluded from GoodRx.
That said, patients can still access the Express Scripts' National Preferred Flex Formulary via the company's own coupon-generating website/app known as InsideRx. I have found that its Express Scripts Mail Order Pharmacy by InsideRx (which is a cash-pay pharmacy) is sometimes the low-price leader on some generic drugs. Rivals OptumRx (owned by United Healthcare) previously offered a similar discount card called OptumPerks https://perks.optum.com/ (but UHC OptumRx quietly sold that venture to a company called RVO Health, LLC and it no longer even has access to OptumRx's complete drug formulary) and the PBM known as MedImpact (which is de facto controlled by Kaiser Permanente, although Kaiser subsequently switched PBMs to Cigna's Express Scripts) which owns/operates ScriptSave WellRx https://www.wellrx.com/ and Americas Pharmacy https://www.americaspharmacy.com/ each offer their own coupon-generating websites/apps.
One PBM I failed to acknowledge was the PBM known as Welldyne Rx, Inc. (and its subsidiary WellDyneRx LLC), which is one of the few PBM's which as of today, still publishes an annual drug trend report which isn't pure fiction or PR fluff. Its 2021 Drug Trend Report can be viewed at https://welldyne.com/wordpress/uploads/2021/06/WellDyne-2021-Drug-Trend-Report.pdf.
Welldyne has a coupon-generating website/app of its own, and it may be worth including among those you search. The reason I omitted it is because it is not currently even in the top 7 of PBM's by volume of prescriptions processed. WellDyne is a smaller-sized, independent (meaning its not owned by a big insurance company-pharmacy conglomerate) PBM with about 2.5 million covered lives, of which about 700,000 are commercial lives. Still, Welldyne is a PBM and it, like several of its bigger rivals, also offers a discount card/app. In fact, the only big PBM's which I don't believe offers discount card programs of their own are CVS Health, and Humana. Maybe they do, or maybe they have ones in development, I simply don't know about them.
Drug Channels lists the top PBM's by market share HERE. For the ease of simplicity, the following slide is courtesy of the Drug Channels institute (I am acknowledging them as the source and including a link to it above).
As noted, much like its bigger PBM rivals Express Scripts, OptumRx and MedImpact, a smaller PBM named WellDyneRx also has a discount card program, although it was moderately more difficult for me to find and use. For example, Welldyne's corporate website barely even acknowledges the existence of a discount card. That may be by design (maybe?). Not every PBM (including MedImpact) acknowledges coupon card programs because they effectively help cannibalize access to the PBM's discounted drugs by anyone with a card, including an individual whose employer hires Welldyne as its PBM, but has a high-deductible insurance plan which requires the covered individual to satisfy a substantial deductible before they are eligible to use pharmacy benefits.
Think of it this way:
Suppose Employer A has insurance thru Anthem, but hires Welldyne as its PBM. That happens. But if Employer A says that a covered individual must first satisfy a deductible of $2,000 before pharmacy benefits kick in, it means the patient is effectively on his/her own to buy prescription drugs until they've satisfied that $2,000 deductible. Instead, the PBM rebates are being given to employers as "premium offsets" rather than going towards patient relief in terms of pharmacy benefits. That happens routinely today.
It happens all the time with companies like Cigna/Evernorth-Express Scripts, United Healthcare-OptumRx, and Aetna (a subsidiary of CVS Health) and its Caremark PBM business. Yet all of these companies' PBM's (except CVS Health's Caremark) are willing to sell access to their drug discount services to anyone with a coupon-card/app, effectively cannibalizing Employer A's pharmacy benefits. Right now, nothing stops that from happening. And, I don't think they could stop it even if they wanted to because the PBM has no knowledge of HR records to know when an individual starts at a company or leaves, even if the corporate parent is exactly the same. So, the PBM discount cards are marketed kind of quietly, on the down-low in order to avoid potential litigation from entities like Employer A.
I tell people with employer-sponsored, high-deductible insurance plans with (for example) United Healthcare which cover virtually no prescriptions until they satisfy substantial deductibles two things:
First, buying drugs at artificially-inflated pharmacy cash prices does not meaningfully satisfy their deductibles. Yes, it contributes SOMETHING, but not nearly as much as they've been led to believe. For example, they might be paying $23.40 to buy 90 tablets of the generic statin rosuvastin calcium (generic Crestor), but they are only being credited about $4.50 for that purchase. The problem is insurance doesn't have to disclose how much pharmacy purchases contribute towards satisfying your deductible. That's a big disconnect. But we know with certainty that's happening all the time. And, they can even use OptumPerks to buy that drug at a deeply-discounted price from Optum! The same is true with Cigna's Express Scripts/InsideRx arrangement.
Second, the solution to their Rx affordability problem is for patients to buy the prescriptions using coupons (many coupons are from the PBM's themselves). The other reality is medical services (doctor's visits, hospitalizations, lab-work (if not covered), etc. will help them satisfy the deductible much sooner than drug purchases will under almost any circumstances because money is being taken away from patient relief by the insurance company to sell more policies. That's pretty sleazy.
Anyway, back to one coupon-generating website/app I forgot to include was one by the PBM Welldyne, The Welldyne coupon card/app is called WellCardRx. Its website is located at https://wellcardrx.com/.
To access it, the company also requires you to complete a form requesting some basic personal information including your name, address and email address. Visit https://wellcardrx.com/get-a-card/ to enroll. One slight oddity is the presence of a field which must be answered called "Referring Group ID", and individuals are required to enter a valid value in that field for the company to send you an active card. However, the tiny text at the bottom of the footnote to that information says:
In order for your card to be active, you will have to write-in (or type-in on the online form) a "Referring Group ID" on the card. If you don't have a "Referring Group ID" (and most people won't unless their employer insurance plan-sponsor has hired Welldyne as its PBM) but the "default" value for this field for individuals whose healthcare plans do NOT use Welldyne Rx as their PBM is: WDRXDEF.
Also, the company says that for the "Member ID" field, individuals may use their 10-digit phone #, followed by a 2-digit person code. Those codes include: 01=Member, 02=Spouse, 03=Dependent, etc.
In summary, the key pieces of info (aside from your name) on your WellCardRx are the following:
Name
Member ID Enter member's 10-digit phone #, add 2-digit person code. 01=Member, 02=Spouse, 03=Dependent, etc.
BIN 008878
PCN WDN
Group ID WDRXDEF
Processor NetCard Systems
To the best of my knowledge, Welldyne does not really "encourage" people to use of its own mail order pharmacy as say Express Scripts does, although I suppose one could try to use that if they are truly interested (and on small-molecule drugs like pills, it may be the easy option).
Still, I did not notice significant discounts by going that route as I did with Cigna/Evernorth/Express Scripts' InsideRx. Many still find it easier to go to pharmacy near them. The site says "To have your prescriptions delivered to your home, enroll in Mail Order". The instructions will require you to enter both a "Referring Group ID" and a "Member ID" in accordance with the info. in the preceding paragraph. I believe because you are using a discount card, and not an insurance plan which uses Welldyne as its PBM, you likely will need this basic info. Welldyne Rx also does say your card must be activated but if you complete the info with the relevant Group ID noted about, and to enroll, they can call the PBM call center at 888-479-2000, its call center representatives are available 24/7 to assist.
That said, I encourage my readers to include WellDyne's WellCardRx https://wellcardrx.com/ to its list of rival coupon-generating websites/apps (among them: SingleCare https://www.singlecare.com/, GoodRx https://www.goodrx.com/, InsideRx https://www.insiderx.com/, OptumPerks https://perks.optum.com/, ScriptSave WellRx https://www.wellrx.com/, America's Pharmacy https://www.americaspharmacy.com/, BlinkHealth https://www.blinkhealth.com/ and ScriptHero https://www.scripthero.com/) to shop for discounted prescription drug prices.
WellCardRx isn't quite as easy-to-use as some of its PBM-powered rivals, but it does appear to offer discounts on authorized-generic insulin (in particular, Lilly Insulin Lispro, not Novo Nordisk Insulin Aspart) but its true generic drug and eventually biosimilar prices are also worthy of searching.
To search prices on WellCardRx, visit https://wellcardrx.com/start-saving-now/pharmacy-savings/ and go to the paragraph marked "Discount Pricing Tool" and select the link to see discount price estimates for prescription drugs in your area. It notes: "Discounted prices are estimates. Savings will be calculated at time of drug purchase."
Beware: you will be asked to enter the drug's name (also beware that some names cannot be found; if they cannot, try searching under the brand-name or drug class such as "insulin" until the name comes up automatically on the website or app) and you'll also need to enter the drug dosage/strength, frequency of dosage, how many units of the drug you're buying (such as tablets, vials of insulin or boxes of insulin pens), how frequently you refill the script, and your zip code. WellCardRx will then provide a list of about 5 pharmacies in your geographic area (based on zip code) plus its own mail-order pharmacy. The search functionality, if I'm being frank, is not great.
It's hard to believe, but Welldyne's site is slightly more cumbersome to use compared to Express Scripts InsideRx is (because that one's actually pretty buggy, although it has far better discounts than rival OptumRx's does). But it may be worth the effort. For example, Welldyne's WellCardRx appears to offer discounts on Lilly Insulin Lispro (the "authorized" generic). Of course, the site says that prices are estimates; you must check with your pharmacist to determine the actual price you'll be charged at the checkout counter. But there are enough prescription drug coupons to include WellCardRx among those you compare prices on.
No comments:
Post a Comment