So Many Ways to Lower Prescription Drug Costs … Which One Is Right for Your Employees?
By Abbie Leibowitz, MD, FACP and Keri Robertson Fuenzalida, DO, FACOEP
Health Advocate
Prescription drug costs continue to climb. What should be a simple pharmacy visit now often turns into a confusing mix of prior authorization and step-therapy requirements, coverage questions, coupon comparisons, questions about copays and deductibles, and denied claims.
The good news is that there are more savings tools available than ever before. The challenge isn’t a lack of options — it’s understanding how they work, when to use them, and how they impact long-term costs.
Today’s prescription savings options
Employees are increasingly turning to a variety of resources to lower out-of-pocket pharmacy costs. Each tool can offer meaningful savings, yet each also comes with tradeoffs that are not always obvious at the pharmacy counter.
Cash-based discount programs
Programs like Rx Shopper from Health Advocate, GoodRx, and Cost Plus Drugs offer alternatives to traditional insurance pricing by providing discounted cash rates.
Health Advocate offers Rx Shopper as an added perk available through our member portal. Rx Shopper is a free prescription discount program that allows members to access discounted pricing at more than 35,000 pharmacies nationwide.
Through the portal, members can quickly download or print their Rx Shopper card and present it at the pharmacy to compare pricing. In some cases, Rx Shopper pricing may be lower than the member’s insurance copay, providing another option when navigating cost decisions.
It’s important to note that prescriptions processed through Rx Shopper, GoodRx, or other discount card programs instead of insurance typically do not apply toward deductibles or out-of-pocket maximums.
The advantage: Rx Shopper is integrated into their Health Advocate experience and supported by the expert guidance of our team of Personal Health Advocates to help determine the most cost-effective choice. This program can create real savings!
While discount programs like Rx Shopper and GoodRx provide discounted cash prices at participating pharmacies to get prescriptions right away, Cost Plus Drugs is a mail order program that uses a transparent model (manufacturer cost plus a fixed markup and fees). For many common maintenance generics, prices are highly competitive. But again, because these prescriptions are typically processed outside insurance, payments generally do not count toward the deductible or out-of-pocket maximum.
Manufacturer copay cards and patient assistance programs
For high-cost medications such as GLP-1 therapies, fertility medications, oncology drugs, and biologics, manufacturer assistance programs can significantly reduce out-of-pocket costs, making them incredibly valuable.
It’s important to keep in mind that these programs often require eligibility screening, enrollment paperwork, and coordination among the provider, pharmacy, and pharmacy benefit manager (PBM). Some health plans also use copay accumulator programs that affect how savings are applied. Health Advocate’s team of Personal Health Advocates understands the nuances of these programs and can help our members through the application process.
TrumpRx (TrumpRx.gov)
TrumpRx, a recently launched federal government website, allows consumers to access discounted cash pricing for certain brand-name medications. The site primarily works as a search tool directing users to manufacturer coupons or direct-to-consumer websites rather than selling drugs directly, though a valid prescription is still required. In some cases, particularly when deductibles are high or coverage is limited, paying cash through the program may be less expensive than using insurance.
Savings vary widely. And like other cash-based options, payments typically do not count toward the deductible or out-of-pocket maximum.
The real issue isn’t a lack of options—it’s knowing how to use them
Each option can offer savings, but navigating them requires understanding program details and plan designs. Is it better to use insurance or pay cash? Will a coupon count toward the deductible? What if prior authorization is required? What happens if the claim is denied?
When employees don’t have clear answers, prescriptions go unfilled, care gets delayed, and health risks increase. Over time, that impacts productivity, absenteeism, and overall healthcare costs.
That’s where Health Advocate can step in to help
Prescription affordability isn’t only about finding the best card or coupon; it’s about simplifying the decision-making process. Health Advocate doesn’t just point employees to tools — we walk them through the decision process. Our experts help employees:
- Compare real-time insurance pricing versus cash options
- Access discounted pricing through Rx Shopper, available directly through the Health Advocate member portal, and other programs
- Identify and coordinate manufacturer patient assistance programs
- Navigate prior authorization and step therapy requirements
- Resolve billing issues or challenge denied claims
- Explain how paying cash versus using insurance impacts deductibles and out-of-pocket maximums
In today’s healthcare environment, making healthcare less complex may be one of the most valuable benefits you can offer. When employees have a trusted advocate guiding them, they’re far more likely to get the care and medications they need at the lowest appropriate cost, with confidence and peace of mind.