Navigating Drug Coverage: How RxUtility Helps You Save Amid Industry Disputes
Politico has a good article about the State of North Carolina dropping coverage after failed negotiations with the PBM CVS Caremark and the manufacturer Novo Nordisk. It's a long piece that does a good job of explaining how those three players - the employer, the insurer/PBM, and the drug maker - determine whether or not people have access to these blockbuster medications. If any of the 750,000 State of North Carolina employees need those medications, they have to pay out-of-pocket. Sucks for them.
The good news is that pharma manufacturers coupons can help. Most of the time, these coupons must be used alongside commercial insurance. But sometimes these same coupons that can be used even if the patient is paying cash and not using insurance.
The bad news is that it is hard to find these coupons and even harder to understand the conditions under which they can be used. For example, Novo Nordisk offers a coupon for Ozempic that lowers the patient’s copay (out-of-pocket) to $25 and can be used for 24 months. It must be used with insurance. There is no cash pay option. Here is the description of the offer from their website:
If you have private or commercial insurance, such as insurance you receive through an employer, you may be eligible to pay as little as $25 for a 1-, 2-, or 3-month prescription (maximum savings of $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription). To receive the offer, prescription must be for a 1-, 2-, or 3-month supply.a Offer is valid for up to 24 months from the date of savings offer activation.
But the same manufacturer offers a coupon for Wegovy that does allow the patient to pay cash. Here is the description of the offer from their website:
Subject to a maximum savings of $225 per 28-day supply (1 box) for up to 13 fills for commercially insured patients with coverage for Wegovy®. If you pay cash for your prescriptions or your commercial insurance does not cover Wegovy®, you can expect to pay $650 per 28-day supply (1 box) of Wegovy®.
Clear as mud? I started RxUtility to shine a light on these coupons so people can find and use them. Us normal folk can’t set drug prices or influence insurance policy coverage. While the big guys fight about this, there is no reason for people to go without.
My hope is that the entire #healthtech ecosystem will plug into the RxUtility API and pull these savings forward anytime a patient’s medication history is touched. Let's work together to help people afford the medications they need.
