Patients across the country are becoming more concerned about how they are going to afford their prescriptions. Even with insurance, out-of-pocket costs can be unpredictable and sometimes higher than expected. Because of this, more patients are choosing to pay cash for their medications.
Approximately 20% of the prescriptions filled under the RedSail umbrella are cash-pay, and that number is expected to grow.
Affordability also affects adherence. As many as 30% of new prescriptions are never picked up, and that can be partially attributed to cost concerns. That’s not just a business issue, it’s a patient care issue. When medications aren’t filled, there are negative outcomes for everyone involved.
To meet the demand for more affordable medications, prescription discount programs—like the popular GoodRx—have started popping up. Many people struggle with out-of-pocket prescription costs, even when they have insurance. So, discount cards have gained popularity to lower medication prices, especially for patients with high deductibles, coverage gaps, or no insurance at all. These cards might have started in the 1990s to help cover seniors before Medicare Part D, but they have now evolved into an industry serving patients at every age.
There are several prescription savings programs that include: manufacturer coupons, pharmacy-specific discount plans, and third-party prescription cards. Manufacturer programs reduce the copay on brand-name medications, and some pharmacy chains offer their own low-cost generic pricing programs to encourage loyalty and visits. The most widely used version of these programs though is the independent discount card model. GoodRx, SingleCare, America’s Pharmacy—all contract with pharmacy benefit managers (PBMs) to offer discounted cash prices. For patients, it’s hard to turn down immediate savings like that.
While patients see immediate savings, they don’t see who the financial burden shifts to. That burden usually falls on the pharmacy they’re filling their prescription at. These discount cards rely on third-party intermediaries, which means pharmacies must relinquish control on pricing and reimbursement. Most of the time, the pharmacy only receives the discounted rate paid by the patient while also paying the transaction fees on the claim. That means reduced margins, hidden fees, negative remittances, and reimbursements that fall below the pharmacy’s acquisition cost. Over time, these losses add up and can create profit issues, especially for independent pharmacies.
Beyond the financial strain, discount card programs can also confuse pharmacy operations. Patients don’t think beyond their own personal savings (who could blame them?), and they don’t realize the pharmacy is losing money as they save. While these programs can help patients temporarily, they also reveal a larger issue that medications are too expensive for a lot of patients who need them most.
So, how do you help patients afford their medications without taking on financial strain personally?
RxAdvantage Automated Cash Vouchers offer an integrated, automated approach to lowering costs for cash-pay patients. Built directly into your RedSail PMS, this solution manages the entire process behind the scenes by evaluating prescriptions for eligibility, applying available vouchers instantly at the point of adjudication, and remitting the full buydown amount directly back to your pharmacy.
Unlike third-party programs, designed to charge additional fees and lower the pharmacy margin, RxAdvantage is designed with pharmacy sustainability in mind. You stay in control of pricing and receive 100% of what you choose to charge for a cash-pay prescription. There are no cards to process, no separate programs, and no hidden fees—just a simple workflow that fits into your existing system.
Patients still get competitive pricing, with discounts being funded by pharmaceutical manufacturers, which improves the chance of them picking up and adhering to their medication, and your pharmacy can protect margins and continue to deliver high-quality care to your community.
As the economy fluctuates, the ability to balance affordability with sustainability will be increasingly important. It is more crucial than ever to adopt solutions that are built specifically for pharmacies so you can meet your patients’ needs without compromising your business’ financial stability.
Ready to learn more? See how RxAdvantage automated vouchers for cash-paying patients can help you stay competitive, improve adherence, and improve your margins.
