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 policy 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 Medicare Part D benefits.
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?
Many Medicare Advantage policies include Part D. 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 today.
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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
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.