Discount Cards: A Rebuttal

August 9, 2019

"The real problem to be solved is “Why do patients struggle to buy their prescriptions?” writes Frisch. 

I read the article titled “Discount Drug Cards Flourish with End of Gag Rule” in the June issue of Drug Topics. While the author provided a comprehensive overview of the usefulness and benefits of drug discount cards to consumers, she neglected to provide any negative comments or feelings from individual pharmacies and pharmacists.

Drug discount cards are promoted as tools to make medications more affordable for many patients. Because of lower drug costs, patient adherence is increased. Per the article, many of these cards also offer apps and educational benefits that address barriers to adherence. 

“What’s in it for pharmacies?” Richard Sagall, president of Needy Meds, talks about the various fees that pharmacies pay in order to process a drug discount card and gives the reasons why a pharmacy should take them. 

About 10% to 15% of all drugs are now purchased by discount plans or coupons. Some programs charge a monthly fee, but others are offered as a benefit to employees or participants.

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While spokespersons for these plans offer a rosy picture, many practicing pharmacists see these programs in a different light. More drug discount cards are being used because so many organizations provide them as a free benefit. Pharmacies are pressured to accept these plans just to stay in business. Drug manufacturers, insurers, and other organizations offer these plans in order to hide the root causes of unaffordable drug prices. FamilyWize’s spokesperson states that the drug discount cards have saved consumers billions of dollars, but have not been well received by independent pharmacies. In fact, the savings are realized on the backs of individual pharmacies who absorb these costs. Profitability is being reduced by these cards.  

What about the services provided by pharmacies? Nowhere in the article does it mention that a pharmacy offers education that may be replaced by an app, but that studies suggest that apps are not as effective as face-to-face contact. It is implied (by omission) that all we do is dispense a product. Pharmacists make available (but are not limited to) recommendations of OTC treatments, provide immunizations and immunization education, and medication counseling. Also, the pharmacist is many times the only readily available health practitioner. 

The real problem to be solved is “Why do patients struggle to buy their prescriptions?” Some reasons are:

  •  High insurance deductibles and copays

  •  Restrictive insurance and PBM formularies

  •  Patients are in the Medicare Part D coverage gap (the donut hole)

  •  Pharmaceutical manufacturers raising their prices way above the yearly rate of inflation

  •  Pharmaceutical manufacturers’ rebates not being passed on to consumers

  •  New drugs that are extremely expensive

 

Doug Hirsch, CEO at GoodRx, suggests five ways to really fix high drug prices.

  •  Stop the rebate and card games

  •  Allow the government to negotiate drug prices

  •  Reduce and/or eliminate patent exclusivity loopholes

  •  Tie drug prices to effectiveness

  •  Government control for crucial rare drugs

He also suggests a single-payer system (Medicare for All) which is used in most countries in the world.

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Ultimately, who pays for the business activities of discount drug cards? It is the pharmacy! Perhaps the large chain pharmacies, warehouse clubs, and grocery stores are willing to accept the extra cost to keep patients coming through their doors. At some point pharmacy leaders will stand up and say, “Pay us for the services that we provide in order to improve the lives of our patients.”

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