Medicine:Co-pay card
 | This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)
(Learn how and when to remove this template message)
|
The co-pay card (also called a copay card or copay coupon) is a form of manufacturer-sponsored copay assistance that reduces a patient’s cost-sharing (e.g., copayments, coinsurance, or deductibles) for certain prescription drugs at the point of sale. These programs are most commonly offered for brand-name drugs, often specialty drugs, and typically apply to people with commercial health insurance. Program details and eligibility rules vary by manufacturer and by drug.[1] As of January 2017, in the United States, coupon cards for more than 600 prescription medications are available.[2]
Based on the National Council for Prescription Drug Programs standard, all pharmacy software systems contain information fields for both a primary and secondary insurer to pay for patient's prescription.
Process
Typically, a patient will receive his/her co-pay card from their physician along with a prescription for the medicine. The patient takes the card and prescription to a pharmacy where the pharmacist enters processing information into his/her pharmacy management system to submit a claim.
Effects
Research has found that copay coupons can increase utilization of brand-name drugs in settings where bioequivalent generics are available, potentially reducing generic substitution and increasing total spending.[3]
Variations
In most cases the service provider of the co-pay card program holds a reimbursement account for the pharmaceutical marketing client, which is used to remit to pharmacies the cost reductions through co-pay card programs. The co-pay service provider remits to pharmacies every 14 to 28 days and deducts these remittances via this account.
Some providers have attempted a variation on the original co-pay card by going to a magnetic strip swipe process, by which the card runs through both the pharmacy software and financial software (e.g. Visa/MasterCard and Debit networks).
Debit cards are another reimbursement method for co-pay in pharmacies because they offer real-time reimbursement of co-pay claims. However, with new prompt-pay regulations for adjudicators, required for Medicare Part D and implemented by most PBMs, few pharmacies wait more than one week for reimbursement. Pharmacies used to prefer real-time Debit payments because they didn't require the pharmacies to carry the "float" of the 14 to 28 days payment cycles. This is no longer true.
Copay adjustment programs
Some insurers and pharmacy benefit managers use copay adjustment programs (including accumulator and maximizer programs) that change whether, or how, manufacturer assistance counts toward a patient’s deductible or annual out-of-pocket maximum, which can affect patients’ net costs over the benefit year.[4]
References
- ↑ "Copay Adjustment Programs: What Are They and What Do They Mean for Consumers?". 24 October 2024. https://www.kff.org/health-costs/copay-adjustment-programs-what-are-they-and-what-do-they-mean-for-consumers/.
- ↑ "Cou-Co Coupon Discount Cards". January 2017. http://www.cou-co.com.
- ↑ Dafny, Leemore; Ody, Christopher; Schmitt, Matt (2017). "When Discounts Raise Costs: The Effect of Copay Coupons on Generic Utilization". American Economic Journal: Economic Policy 9 (2): 91–123. doi:10.1257/pol.20150588. https://www.aeaweb.org/articles?id=10.1257%2Fpol.20150588. Retrieved 5 February 2026.
- ↑ "Copayment Adjustment Programs" (in en-US). https://www.ncsl.org/health/copayment-adjustment-programs.
 |  |
