Curiouser and curiouser…..
There was a time when PBMs condemned the use of Rx discount coupons saying that doing so upsets the delicate balance of reimbursement set by the great minds within the same PBMs.
Well, as Bob Dylan sang, The times they are a changing.
Express Scripts (ESI) now appears to be embracing the concept of Rx discount coupons. They have come to realize that they are losing volume/$$ when consumers access the discounts offered by GoodRx, for example. As we now know, those consumers can save significant out-of-pocket bucks….. even if the spend doesn’t count against their deductible. ESI has partnered with Amazon’s Rx discount card to power the program.
ESI also seems to be in a generous mood.
They say that they will apply those discounted transactions against members’ deductibles and per the member’s benefit.
Is this a PBM gettin’ religion? Maybe not.
It is presumed that ESI will be able to still qualify for a rebate on the transactions that it processes.
Express Scripts Will Combine Coupons With Pharmacy Benefit
Express Scripts, the PBM subsidiary of Cigna Corp., will allow members to combine prescription drug coupons with their traditional pharmacy benefits. Pharmacy insiders tell AIS Health that the new offering is likely meant to head off competition from GoodRx Inc. and other upstarts.
Program Expands on Cigna’s Amazon Partnership
“Right Price alleviates the need for a member to price shop, and allows for the medication purchase to apply toward their deductible, if they have one,” writes Matt Perlberg, Express Scripts’ senior vice president for supply chain, in a November blog post about the program. He adds that “the claim is processed within the benefit” and “Right Price also allows members to leverage discount card pricing at our industry leading Express Scripts Pharmacy.”
In addition, members using Right Price have access to Amazon.com Inc.’s discount card as part of “our newly expanded relationship with Amazon.”
Is the New Product Just Branding?
Elan Rubinstein, Pharm.D., principal of EB Rubinstein Associates, panned the concept. He suspects the offering is simply a play to ward off GoodRx. “It seems to be a branding exercise,” Rubinstein wrote to AIS Health, a division of MMIT, in an email. He suggested the reason for the product is “perhaps there would be a cost to Express Scripts” if it created a formal arrangement with GoodRx.
“They’re losing customers to GoodRx,” says Ge Bai, Ph.D., a professor at Johns Hopkins University’s schools of business and public health. “Not just Express Scripts — these PBMs are seeing some of their insured patients go to GoodRx to use the cash price — the so-called cash price.”
Express Scripts Seeks to Retain Rebates
“The problem [for Express Scripts] is these patients….They’re bypassing their PBM. So I think this is related to that concern,” Bai explains. She also thinks the partnership with Amazon is significant — in her view, Express Scripts would rather split discount card revenue with Amazon than lose it altogether.
Bai thinks this arrangement could wind up costing plan sponsors. “If they go to GoodRx, the employer doesn’t pay anything,” she says. However, by combining coupon savings with a normal rebate arrangement, Express Scripts still gets its normal cut of the rebate but slightly discounts the cost to the consumer at the point of sale.
by Peter Johnson, Radar on Drug Benefits