Rx Copay: Daddy’s Credit Card

creditDrug costs are skyrocketing and account for as much as 25% of total health care spend for plan sponsors. Most plans continue to cover prescription drugs through an antiquated system established years ago when drugs were relatively inexpensive.

By Molly Mulebriar

Prescription pharmacy benefit managers take the “management” function of purchasing prescriptions away from the end user. Instead, the only management responsibility of the consumer is to manage to come up with a cheap copay. For example, a generic drug is purchased for $10 while a brand name drug costs $25.

Unfortunately for the poor plan sponsor, these types of prescription drug plans have become much like Daddy’s credit card.

If plan participants were to have to pay up front before reimbursement through a self-filed claim (remember the old days?), they will, for the first time  (1). know what the real cost is and(2). have skin in the game. Human nature as it is, consumers will be motivated to ask questions and seek lower cost drugs in lieu of the “purple pill.” Money affects behavior.

Removing Rx copays is worth at least 10% in savings while the ” shoe box” effect provides even more.


In light of your post today on Rx benefits, please be introduced to SimpleSaveRx.  It is a totally pass-through PBM that allows the pharmacies to compete with one another on price.  The plan sponsor sets its contribution amount from the bottom, and then the pharmacies’ prices are available to see to each patient so that they can shop for the best price, ergo which ever gives them the lowest out-of-pocket.    The plan’s contribution remains fixed – essentially a reverse co-pay.  SSRx only makes a PEPM fee; all other costs are passed through.  Seems pretty cool to me.   Thoughts?