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Helping Your Patients Navigate Co-Pay Coupons

As a health care provider, you help your clients get the prescriptions they need at the lowest price on the first trip to the pharmacy. Many patients have access to coupons, yet it can sometimes be confusing for the patient to figure out how to best claim the coupon benefit. In a recent article, Steven Leon MS, PA-C, discusses how prescribers can help patients understand insurance and coupon coverage and offers practical pearls to help ensure patients get on the regimen they are prescribed.

Insurance: Gather a Basic Understand of Coverage for Brand Name Drugs

One of the most important pieces of information you can know for your patients is how much the drug costs. The obstacle in this task is accessing that information against a patient’s particular insurance plan, which is data only available to a pharmacist. Epocrates is one of the best resources available to you and your patients concerning the costs of medicine.

Coupons: Know How They Work

Brand name coupons became available so pharmaceutical companies could make drugs more affordable. Most of these coupons offer deals that are variations of the “pay no more than X”, which work successfully if the patient has a normal co-pay. However, patients with higher co-pays may end up paying more than the coupon’s face value. Sometimes, unfortunately, these coupons are rejected because the medication requires prior authorization, is not covered, or the co-pay is still too high for the patient, who leaves their pharmacy empty-handed and frustrated.

The remedy? Be knowledgeable on the coupons you provide to clients. It’s wise to mention to your patients that no federally funded programs accept coupons. Refer your patient to the fine print on the back of the card and pay special attention to the maximum benefit. It’s also beneficial to know if a coupon will be accepted without prior authorization. Often your pharma representative will be able to answer this question for you.

Practical Pearls for Helping a Patient Use a Drug Coupon:

If you prescribe a brand name drug with a coupon for your patient:           

1. Explain why you’re prescribing the brand name over the generic brand. Leon suggests conveying the information in a “one is excellent, the other is good” scenario so the patient can feel satisfied with whatever option they choose.

2. Educate your patient about the process of obtaining a name brand medication, and establish realistic expectations surrounding the processing time, coupon, coverage, and costs.

3. During their follow-up appointment, ask your patient if they were able to obtain their prescription, and if the coupon worked.       

Some things to consider if you receive a call from a pharmacy:

1. Ask the pharmacist if they accessed the hotline indicated on the back of the card, which is where he or she can obtain proper codes and instructions on how to bypass the processing barrier.

2. If they called the coupon’s hotline and are still unable to move forward, you can advise your patient to go to a different pharmacy (preferably one that you have a relationship with and that you know is proficient in processing coupons), or substitute a suitable generic medication, and inform the patient of any changes.

Our ultimate goal as PAs is to do what is best for our patients.  By helping patients navigate the complicated world of insurance options and drug coupons, we can be an advocate for our patients and help to make sure that they get the best medicine they need. 

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Image: Ruth 138

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