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COPAY ASSISTANCE COUPON INFORMATION - (4/5/2021)
Information on why Manufacturer Copay Assistance Coupons are not accepted at Express Scripts’ Pharmacy:
Coupons are offered for a brand drug that most often has either a generic alternative or a preferred formulary brand alternative available on the market. Coupons that provide manufacturer copay assistance for members drive up the cost to a plan sponsor by attempting to override generic incentives, formulary incentives, or preferred/ cheaper pharmacy channels ( mail versus retail pharmacies).
- Coupons are used by manufacturers as a form of advertisement to members, enticing them with lower copays to use their medication. A member may find that the coupon allows the medication to be affordable, where before the coupon, the same member may have reached out to the physician to prescribe a preferred, cheaper alternative as they share the cost of the medication with the plan.
- By utilizing a coupon, the cost to the plan is increased as the Fund will pay more for the non-preferred medication compared to a preferred alternative. This fact is often overlooked by members as they are concerned about their final cost when they pick up the medication. This drives up the Fund’s costs as the plan is responsible for paying for a more expensive medication, which, in the long run, can affect the members’ contribution costs as a result.
- It is important to note that a claim using a coupon will circumvent member out of pocket (OOP) accumulators tracked by the plan. By using these coupons, members are no longer paying their expected full cost share on the pharmacy benefit for an expensive brand medication. This increases plan costs as members meet their out of pocket sooner during the plan year without paying the full amount themselves.
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