Louis Tharp Answers Questions about Co-Pay Cards

I’m going to assume you all know about co-pay cards. If you don’t, here is the one-sentence explanation: You get them from your physician and you give them to the pharmacist when you get a prescription filled. They either cover your entire co-pay or part of it. Either way, they’re good for you.

When your doctor writes a prescription, ask if there is a co-pay card for the drug. If there is not, ask  if another drug with a co-pay card can be substituted. Save your money.

So who pays your co-pay when you use the card?

The pharmaceutical company that makes the drug.

Why does a pharmaceutical company want to pay your co-pay?

Because health insurance companies are restricting the kind and amount of drugs your physician can prescribe. It’s not about generics vs. brand-name drugs, it’s about how cheaply the health insurance company can buy the drugs from the pharmaceutical company. For example if an insurance company can force you to take only one brand/generic drug for something like hypertension, then that insurance company can negotiate a cheap price for the drug based on volume. If you want another drug, sometimes the insurance company will say, “ok, but you have to pay a higher price,” so the pharmaceutical companies try to subsidize that cost by offering free-co-pay cards.

So everybody wins, right? The insurance company pays less, so my premiums stay low.

Not exactly. The insurance company wins when they put restrictions on what drugs you can take. Only if there is a co-pay card for that particular drug. If not, you lose. And, most importantly, not all drugs are alike. When an insurance company cuts a deal for a large volume of a certain drug and then forces people to use only that drug, they are ignoring the fact that your doctor may not think that particular drug is right for you. The doctor loses the ability to prescribe the drug that is right for you, you lose the therapeutic value of the denied drug, and you lose the co-pay assistance.

Why don’t health insurance companies like co-pay cards?

If the co-pay card is for the drug they have bought cheaply and force you to use, then they don’t care. But if the co-pay card is for a drug the health insurance company does not get a good deal on, they pay more when you take it. It is more expensive for them to buy. This extra cost comes right off their bottom line, and health insurance companies are in business to make money.

What can you do?

If your doctor thinks the drug for you is the right one, ask your doctor to fight for you. You can also fight for yourself so you can get drug you need to be taking. Call, write and go to healthcare blogs and discussion boards like ours and make your feelings known. Send me an email and let me know whether you are successful or not. We are willing to help you get the right drug — the drug your doctor prescribes — at a fair price.

Interested in swimming? Louis Tharp has written a book about his experience coaching the West Point triathlon team. Learn more about his coaching and his own competitive swimming achievements at www.overachieversdiary.com

Louis Tharp is also the swim coach for professional triathlete and West Point graduate, Nicholas Sterghos. Learn more about Nicholas at www.nicholassterghos.com

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