The co-pay card appeared in 2005 as a means by which pharmaceutical marketers could, by offering an instantaneous rebate to patients, combat their challenges to prescription pharmaceuticals, including generic competition, lack of patient compliance and persistency, and an access to the physician population. As of January 2017, in the United States, coupon cards for more than 600 prescription medications are available. Based on the National Council for

Prescription Drug A prescription drug (also prescription medication, prescription medicine or prescription-only medication) is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs c ...

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 A management system is a set of policy, policies, business process, processes and procedures used by an organization to ensure that it can fulfill the tasks required to achieve its objectives. These objectives cover many aspects of the organizati ...

to submit a claim. If a patient has insurance, the pharmacist will key in the patient's insurance number in the

primary field In theoretical physics Theoretical physics is a branch of physics that employs mathematical models and abstractions of physical objects and systems to rationalize, explain, and predict List of natural phenomena, natural phenomena. This is in co ...

and an identifier from the co-pay card into the secondary insurer field. Instantaneously the pharmacy benefit manager provides

coverage data A coverage is the digital representation of some spatio-temporal phenomenon. ISO 19123 provides the definition: * '' feature that acts as a function to return values from its range for any direct position within its spatial, temporal or spatiote ...

, relaying the patient's out of pocket, or co-pay to the secondary insurer's benefit manager, who then provides a discount accordingly. An example: A brand offers a co-pay card giving patients the opportunity to save up to $20 off each prescription fill. A patient receives the co-pay card and visits their pharmacy. The patient provides his/her insurance card and co-pay card to the pharmacist. The pharmacist enters information into his/her pharmacy management system from both cards. The insurance benefit manager recognizes the drug as a TIER 3 brand for the patient and relays the patient co-pay to be $30.00. The co-pay card benefit manager recognizes the $30.00 and covers the $20.00 of co-pay, leaving $10 for the patient to pay out of pocket. Another patient without prescription insurance coverage follows the same process. The co-pay card takes the primary insurer position where it recognizes the claim as that of a cash-paying patient and applies $20.00 discount to the patient's out-of-pocket costs.

Variations

In most cases the

service provider A service provider (SP) is an organization that provides services, such as consulting, legal, real estate, communications, storage, and processing services, to other organizations. Although a service provider can be a sub-unit of the organization t ...

of the co-pay card program holds a reimbursement account for the

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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

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(e.g. Visa/MasterCard and Debit networks).

Debit card A debit card, also known as a check card or bank card, is a payment card that can be used in place of cash to make purchases. The card usually consists of the bank's name, a card number, the cardholder's name, and an expiration date, on either ...

s 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.

References

{{Reflist Pharmaceutical industry