What is GoodRx?

How does GoodRx work?

GoodRx has become a household name for pharmacy savings. They were recently ranked №6 on the 2019 CNBC Disruptor 50 List, claiming to of saved American consumers $10 billion on prescriptions. It’s common for me to go into an open enrollment meeting and have employees ask about the tool. Though the company has done the good work of making drug transparency mainstream, there are areas of caution many consumers aren’t aware of until they attempt to use the application or view their claims after using a GoodRx provided coupon. Here is a list of examples of when it’s a bad and good time to use the cost-savings tool.

You should not use GoodRx when….

www.goodrx.com

 

My Health plan

You will easily meet your deductible. If you are on a consumer-driven health plan (CDHP) with an HSA, prescriptions are covered at a copay once you hit your deductible. If ongoing care and the cost of your prescriptions will get you to your deductible quickly, without using the GoodRx prices, consider doing this. You will have to compare the total cost of meeting the deductible + out of pocket costs (copays and coinsurance) vs the savings with GoodRx.

You qualify for a patient assistance program. Many high-cost prescriptions have an assistance program to help consumers receive the drug at little to no cost if you qualify based on your level of insurance coverage, household income, and out-of-pocket medical expenses. These savings do not count towards your deductible, however, they may provide more savings than GoodRx.

You should use GoodRx when….

You are on a CDHP with an HSA and you won’t meet your deductible. The average health plan deductible is $1500 for individuals. On a CDHP, you will generally have to meet your deductible before prescriptions are covered. If you are taking a prescription which offers a discounted price through GoodRx which is less than you would pay using your insurance, and you do not expect to meet your deductible, then using the GoodRx price might make sense for you. Consider you will pay $15.75 using GoodRx for the drug Divalproex which is used to prevent seizures for patients with epilepsy. Through your plan, the drug costs you $26.01 each month. If you do not think you will meet your deductible with other health care expenses, it would make sense to receive the discounted price and not submit the prescription claim to your insurance.

You are in a short term health plan. Many short term health plans do not include prescription coverage. Short term health plans do not have to abide by ACA guidelines and with pharmacy being a high-cost expense, the carriers can keep the premium low by leaving pharmacy out of the policy. If you are currently enrolled in this type of health plan you may benefit from the cash prices on GoodRx.

GoodRx certainly has its place in the healthcare market. They have brought light to the lack of transparency within the pharmaceutical industry and they have given some control back to consumers.

The Hard Truth: GoodRx is paid by the same industry they are disrupting. They receive revenue from pharmacy benefit managers (PBM) just as the insurance carriers do. Essentially GoodRx has cut out one middle man in the prescription buying process and inserted themselves as an alternative, none of which actually impacts the unfair price gouging of the pharmacy industry. The savings may make sense in the short term for a consumer, however, we will continue to face unaffordable prescriptions until the light is shined on the unfair practices within the entire pharmaceutical ecosystem.

Jessica Du Bois is an Employee Benefits & Healthcare Consultant in the Washington DC region. Jessica helps companies reinvent their benefits program by creating an enjoyable user experience and implementing cost- containment strategies.

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