Understanding Your Copay on Prescriptions

What is a prescription Copay?

If you are lucky enough to afford a decent medical insurance plan, you might never think about a prescription drug’s price. After all, your insurance has you covered, right? All you need to do is pay your designated copay on prescriptions when filling your order at the pharmacy and sleep easy knowing your insurance is working for you.

Unfortunately, paying your copay on prescriptions might not be in your best interest. In many cases, you, the patient, end up paying more than you need to with your insurance prescription copay than you would without it. In other words, you’d be better off if you just paid cash!

To help you better understand why this is, it’s important to understand just what a prescription copay is.

Copay on Prescriptions

What is a prescription copay?

The prescription copay is a fixed amount for every medicine on a particular tier in your insurance plan’s formulary. The formulary in your plan is a list of generic and brand-name prescription drugs that your insurance plan covers. The formulary is divided into several tiers that determine the copay amount you must pay, regardless of the drug’s retail price.

How is Prescription Copay Determined?

Your plan’s formulary is essential. Not all plans cover every drug. It is advisable to check your plan’s formulary against the list of medications to see if your prescription is covered. The formulary is divided into four groups or tiers.

The various tiers are divided by the insurance company to cover different price points. Each tier indicates how much your prescription copay will be for a covered drug within the tier.

  • Tier 1 drugs typically include generic medicines with the lowest copay.
  • Tier 2 might have specific brand name drugs that your insurance company prefers.
  • Tier 3 may have non-preferred brand name drugs.
  • Tier 4 typically has the most expensive drugs that could be specialty medications for complicated issues.

Why Prescription Copay is Not Always The Best Way to Go

Now here is the kicker: Just because your insurance plan covers your prescription does not mean you’re not overpaying for your medicine. The copay amount is determined by the tier that your medicine belongs to. The amount has nothing to do with the actual retail price of the drug. Your insurance plan sets the prescription copay.

All too often, the copay amount is more than what you would pay for a drug if you just paid cash. According to researchers at the University of Southern California, out of 9.5 million claims analyzed over a single year, almost 2.2 million of them involved copay overpayments.

That is 2.2 million, or 23% of people paying more for their prescriptions because their copay was higher than the cash price of the drug itself. The average overpayment was $7.69, but one in five cases saw people overpaying $10 due to their copay amount. If you add the amount up, people paid overpaid a $135 million in this small study alone!

Where does all the extra money go? This difference between the retail price and copay is split between your insurance provider and what’s called a Pharmacy Benefit Manager. The sad reality is that this is an entirely legal process.

However, the legality of this does not make it right. There is a better solution to help patients who have medical insurance protect themselves from overpaying. It’s called myRxMedSaver.

Never Overpay For Prescription Medications Again

Protect Yourself With MyRxMedSaver

myRxMedSaver is a prescription drug discount app that helps you determine the cash price of any prescription medicine you want to buy. When you know the actual retail price of the drug, you can compare it against the copay in your plan’s formulary and decide whether you want to pay cash or through the plan.

It works in three simple steps:

  1. Present the myRxMedSaver to the pharmacist at the counter when you are checking out.
  2. If the retail price is lower than your prescription copay, you can forget about using your plan.
  3. Pay cash and pocket the difference.

You might be surprised to learn that there is a difference between 10%-85% between the copay and the cash price. The myRxMedSaver discount prescription program can save you a substantial amount, and it’s super easy to use!

To begin using myRxMedSaver, download the intuitive app for your iPhone or Android phone, or print a discount card and keep it in your wallet.

Show MyRxMedSaver to your pharmacist for every prescription, every visit to the pharmacy, and protect yourself from prescription copay overpayments.

Will myRxMedSaver save you money?

Take the myRxMedSaver Copay Challenge and see!

Discount card program. myRxMedSaver is not insurance.