Question: Why do I need a prescription drug plan if I can get my medications through GoodRx?

Answer: I have been hearing about GoodRx more and more. I see the commercials continuously on the TV and in magazines. I have many clients ask me about GoodRx.

First, let me clarify “why you need a Prescription Drug Plan?” If you are eligible for Medicare and enrolled in Medicare Part A or Part B or both, there is a law that requires you have Prescription Drug Coverage. There is a “minimum standard plan” that your Prescription Drug Coverage Insurance must meet (creditable coverage). If you don’t have that “Minimum Standard Prescription Drug Coverage,” there is a penalty that is enacted for the months you don’t have that Prescription Drug Coverage, if you decide to enroll later.

What I am trying to convey is that if you have Medicare or are eligible for Medicare, you should have some sort of Prescription Drug Plan (insurance for your medications).

When we work with seniors to find the best possible prescription drug coverage for them, we evaluate the plans based on where they prefer to buy their medications, what medications they take, and what their other healthcare needs are. We do this using the www.medicare.gov website.

In doing this evaluation, we often discuss that the same medications at the same pharmacy can have vastly different prices, based on the insurance product we are reviewing. We also find that by switching to an alternative pharmacy, we may be able to save money on the cost of the medications.

GoodRx operates on the same principle in a different way. First, GoodRx is not an insurance product. It is a company that has made its business model based on finding you the best possible price for your medications. It can be used by anyone, anywhere.

The company searches websites and stores and pricing to produce the lowest possible prices for you to buy your medications. It does not require you become a member, it does not require personal information.

GoodRx works with the internet and your ability to print off coupons from your computer, or a computer at a public library, or using your smartphone to show the coupon to the pharmacy to get your savings. If you do not have access to the internet, or know how to use a computer or have a smartphone, GoodRx cannot help you. Although, I have been at the pharmacy where the pharmacy staff have used GoodRx to save a customer money.

When you enter a medication on the GoodRx website, it searches all the pharmacies and all the deals available, and based on your zip code, will filter the pharmacies near you. If you do not enter your zip code, you can scroll down through the pharmacies to find your best deal locally and then go to that pharmacy. The website is shopping for you and then showing where you get the best price.

You can go to that pharmacy, or you can use the GoodRx information to get your best possible price at your pharmacy.

There are situations where the GoodRx price is better than your insurance coverage price. You cannot use both; it is one or the other. Usually when our doctors call in or email medications to the pharmacy, the pharmacy fills them using your last known insurance. When you know what the medication is, you can look it up at GoodRx and look at your pharmacy and the price it lists for that medication and the dose your doctor prescribed. The cashier will tell you what price your known insurance coverage is charging you for the medication. You can compare that to GoodRx price and then choose which one.

If you switch to the GoodRx price, realize that the cashier/pharmacist must pull it out of your insurance and then re-ring it up using the GoodRx coupon. This will take some time.

When you choose the GoodRx coverage, it means your prescription co-pays are not going into your Prescription Drug Coverage phases of coverage. Your co-pays are not being processed by your EPIC coverage, if you are eligible for EPIC. If GoodRx saves you enough money, that may be worth it, that is for you to calculate.

I do recommend looking up the GoodRx pricing before you are standing in line at the pharmacy. You need to be aware of what GoodRx can do for you, but you should not stand at the register trying to figure all this out, while other customers line up behind you.

Using GoodRx is similar to clipping coupons for the items you buy regularly. You know that you will be needing toothpaste and deodorant, so you clip the coupon, buy the product you want and then give the coupon to the cashier. That reflects the similarity.

The difference between coupons for goods purchased that way and medications purchased at the pharmacy is that GoodRx does not also give you the store advertised low price and the GoodRx coupon. You have to use the either/or.

It is also important to understand that there are medications that GoodRx will not work for at all. This tool is designed to work the best with generic medications. It can work with some Brand Name medications, but not all. It also may not work with controlled substances,usually pain medications.

GoodRx also has telephone support if you run into questions or problems with your medication coverage. Their phone number is (855) 268-2822, Monday-Sunday, between the hours of 8am and 7pm CST. You can call this number if you have questions about working with your pharmacy to get your medications filled, if your pharmacy refuses to fill your medications using GoodRx, or if you have general questions about GoodRx.

Let’s go back to your initial question, “Why do I need insurance if I can use GoodRx?” GoodRx is not insurance.

If you have Medicare you have a requirement to be enrolled in an approved (creditable) Prescription Drug Plan. If you choose to not have a creditable drug plan, you are accruing a penalty for every month you are without Prescription Drug Coverage. During this time of no coverage you may be able to save money on your medications using GoodRx.

I would instead recommend: enroll in a Prescription Drug Plan. Then in addition, review the pricing of GoodRx. Using both these tools, you can save as much as possible on your medications. It is not bad to use both. It is smart to use both. That saves you as much money as possible.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.