Manufacturer Rx coupons are a great way to lower the cost of prescription drugs. However, using Rx coupons and Medicare simultaneously to pay for medications is illegal. Thus, if you have a Medicare Part D Prescription Drug plan and wish to use a pharmacy coupon, you must choose one or the other each time you pay for your prescription drugs.
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Why Can’t Medicare Beneficiaries Use Rx Coupons?
There is no legal implication to using Rx coupons when you have Medicare. But, combining the prescription coupon with Medicare Part D coverage is where the line blurs.
Using Rx coupons in conjunction with Medicare Part D coverage is illegal nationwide. When using Rx coupons, you must opt-out of using your Medicare Part D coverage.
If the Rx coupon offers your drugs at a lower cost, you may use the coupon rather than your Medicare Part D benefits. However, if your Medicare Part D plan covers the drug at a lower cost, you should stick to your drug plan.
It is essential to do your research beforehand, as pharmacies can leave your options unclear. Going in blind makes it hard to decide which option is the most cost-friendly.
Medicare beneficiaries are not barred from using Rx coupons. They will just need to ensure they are not combining Rx coupons and Medicare benefits at the pharmacy.
Best Prescription Discount Cards
Several programs offer Rx coupons, discounts, and promotions at the pharmacy. Often, these programs provide members with a savings card to use at an eligible pharmacy.
The eight most popular Rx discount programs are:
- GoodRx
- Optum Perks Script Relief
- SingleCare
- ScriptSave WellRx
- Blink Health
- The U.S. Pharmacy Card
- Medicare Plus Card
What is The Anti-Kickback Statute?
Social Security Amendments of 1972 made it illegal for pharmaceutical companies to give discounts for any medications bought through Medicare. The 1972 Amendments also include the Anti-Kickback Statute. This statute makes it unlawful for anyone to offer drug coupons and rebates to customers for items or services for which a federal healthcare program pays.
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When a pharmaceutical company suggests you choose a more expensive drug option, Medicare spends more money than if you chose the lower-cost generic medication. Although the manufacturer offers a discount, coupons are generally for their newest and more expensive medicines.
Also, these drug coupons usually have a short lifespan plus an annual maximum cost. Thus, you and Medicare would be responsible for paying the remaining amount for the rest of the year.
The Anti-Kickback Statute prevents individuals from abusing the system. In turn, Medicare reduces cost spending.
Can Medicare Beneficiaries Use GoodRx Prescription Coupons?
Medicare Advantage plans may include Part D drug coverage. In this case, just like with Medicare, you can use either your built-in coverage or a discount drug card. You can use your discount card on your prescriptions if it saves you more money than your Medicare Advantage plan.
However, for those who have a Medicare Advantage plan without drug coverage, Rx coupons could be a great source of savings when visiting the pharmacy.
Rx Coupon FAQs
How to Use Prescription Coupons When You Have Medicare
When a prescription coupon presents itself for your use, it is essential to know the rules and regulations around using the discount. Drug discount coupons and cards can seem appealing to help you save money, especially on a fixed income. Yet, it is essential to be informed about the facts.
That's where we can help. We have assisted countless beneficiaries in signing up for the right Medicare Part D prescription drug plans, and we can do the same for you. Just call the number above or fill out an online rate form to get started.
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- What is the Anti kickback statute, American Bar. Accessed April 2022.
https://www.americanbar.org/groups/young_lawyers/publications/tyl/topics/health-law/what-is-anti-kickback-statute/ - Discount Drug Card, CMS. Accessed April 2022.
https://www.cms.gov/newsroom/fact-sheets/medicare-prescription-drug-discount-card-and-transitional-assistance-program
Why can’t that law be changed to allow people on Medicare to use manufactur coupons?
Hi Shari, if you have a Medicare Part D plan, you may choose to use a manufacturer coupon in place of your Part D coverage. However, using both would be counterproductive as manufacturer coupons often will cost you less out of pocket than your plans copayment.
If a CGM falls under part B coverage but you get it at the pharmacy, can you use goodRX in conjunction with the insurance?
Melinda, You are never able to use insurance coverage and GoodRx. In this case, you would need to see which option covers you best.
Is there a distinction to be made between using a discount card versus a manufacturer’s coupon? i.e. GoodRX versus Mfg coupon for Livalo ($18) Could you explain the difference between the two and whether or not they are both “legal” when purchasing a medication without using Medicare Part D?
Kris, discount cards and manufacturer coupons can be used at any pharmacy that will accept them. The only stipulation is that you are not able to use the coupon or discount card in addition to your Medicare coverage and can only use either a discount card OR coupon. It is also important to know, discount cards are available to everyone, and manufacture coupons are given on a need’s basis by the manufacturer.
I have noticed a lot of the manufacturer’s coupons now read that you cannot use the coupon if you are “eligible” for any government sponsored coverage. Example: “ This offer is invalid for patients without commercial drug insurance or whose prescription claims for Trulicity are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state patient or pharmaceutical assistance program.” The pharmacy will not allow you to use the coupon instead of your Medicare plan based on that wording.
Very good information on high dollar drugs and the use of coupons. You would think Medicare would want to pay the lowest price possible and pass it on to the beneficiary. My sister could pay $174 a month for a drug she needs by using a coupon whereas through Medicare she would have to pay $561 per month. Doesn’t make any sense.
Peggy, we understand your frustration. Unfortunately, each drug plan uses a different formulary which covers drugs differently depending on the pharmacy you use. If you can find a coupon to lower your drug cost, you can always use the coupon rather than your Part D coverage.
so then… if I am understanding… one can be on Medicare and SSA or SSDI and use a Manufacturers Savings Card for a prescription drug long as long as you don’t have Part D coverage correct?
KC, Part D drug coverage can definitely be confusing! If you are using Part D to cover a prescription, you would not be able to use the manufacturer savings card in addition to your Part D coverage. However, if you wanted to use the savings card in place of your Part D coverage, that would be acceptable. You can always use one or the other, but you cannot stack coverage.
If I use goodrx for a discount does the money I pay go toward my part D deductable?
Hi George – no, the money does not go toward your Part D deductible because you can’t use Part D and GoodRx in conjunction with each other. While you can keep Part D and use GoodRx discounts for your prescriptions, you can’t use both at the same time.
Since I take few prescription drugs, I never reach my deductible, consequently I pay full cost for my drugs as well as a monthly charge to my prescription drug plan (which just went up). Should I just use my Good Rx coupon?
Hi Norma – if you get a better deal from the GoodRx coupon, you can choose to use it in that circumstance. Yet, we wouldn’t recommend unenrolling from a Part D plan entirely; gaps in creditable drug coverage will expose you to a penalty in the future.
I tried to havr my pharmacy use manufacturer coupon instead of my medicare part D prescrip plan and they said I could NOT?????
Hi Maureen – you should be able to use the coupon instead of your Part D plan. You just can’t use it in conjunction. Ask to speak to the pharmacist if you only spoke to a tech.
So, can I tell my pharmacy to use my copay card (free drugs) instead of my supplemental insurance I purchased last month?
Hi DJ, yes – if the drugs are lower in cost with a discount card, you can use it instead of your Part D insurance. Additionally, other than Part D and Advantage plans, no other supplemental Medicare insurance covers prescription drugs, as Medigap plans cover the same as what Medicare does.
Can you use the coupon if you have medicare part B?
Hi Monique, you can use prescription discount coupons if you have Part B, an Advantage plan with prescription drug coverage, or even Part D! The only caveat is that you can’t use them in conjunction with each other.
Thanks for a great article. Can you specify exactly which CMS provisions allow a Medicare recipient to choose whether to utilize a manufacturer’s coupon or their Medicare coverage?
Hi Sharon! You can tell the pharmacy to use your coupon instead of your Part D plan at any time.
Jagger, would you please answer the question which has been asked twice, now for the third time? WHAT IS THE CMS cite for what you are saying????? If you don’t have time to look it up, or don’t know, get some help. You are giving advice that people can use a coupon if they are willing to pay out of pocket when Medicare DOESN’T COVER a prescription. “Can you specify exactly which CMS provisions allow a Medicare recipient to choose whether to utilize a manufacturer’s coupon or their Medicare coverage?”
Hi Mona. It is always your discretion whether or not to use your Medicare Part D plan. For example, if you find a coupon (such as GoodRx or a manufacturer coupon) allows you to receive a drug at a lower cost than your Medicare Part D plan, you can choose NOT to utilize your Part D plan to cover the drug and use the coupon instead. However, you can never use a coupon in addition to your Medicare Part D plan. You can find more information regarding your Medicare Part D plans by reading the CMS Medicare Prescription Drug Benefit Manual.