Card Tricks: Pharmacy Benefit Managers (PBMs) and Discount Card Providers are Teaming Up, but Is It Really Putting Patients First?


In recent years, the healthcare industry has undergone significant changes driven by technological advancements, evolving regulations, and innovative business partnerships. Several recent announcements have revealed that PBMs are starting to create direct relationships with discount card providers and that may cause some people to ask, why would a PBM need a discount card partner? Aren’t they supposed to be able to negotiate the lowest rate across their covered members? Why would they need to be able to access other PBM rates or, presumably, be able to offer rates from another of their own plans? Let’s dig into the card tricks to understand why it is good for some patients, but may not be for all patients.


With the growth of industry stalwarts like GoodRx, PBMs have started to see the proverbial writing on the wall, in that, the perceived value of a PBM is diminishing. Why would a plan sponsor want to pay thousands of dollars for a coverage plan when there are so many options available to everyone willing to search online? Wouldn’t it be better to just educate the patient that other options exist?


Well, PBMs are now fighting back by simply including the discount cards automatically to their plan design. On the surface this sounds great, patients are lowering their prescription costs and plan sponsors get all the claims data to ensure medication compliance for their covered members. PBMs aren’t doing this out of the goodness of their hearts though, they are just getting reimbursed by the discount card provider even for allowing patients within their own pharmaceutical plans to use other plans within the same PBM. This reimbursement occurs because the PBM is then acting as a distribution partner for the discount card provider which is potentially a grey area especially when they are allowing patients to access other pricing that the PBM itself controls.


Regardless, patients that are on a given PBM with a discount card partnership, will benefit by getting the automatic price reduction on their medications, that’s good, right? Well, what happens when a patient is on a UnitedHealth Care plan filling at CVS. They will also get the same level of support because they are filling at CVS, right? No. Any patient that is on a plan whose plan sponsor (e.g. employer) has not opted to include the discount card pricing option, presumably because of extra fees, will not benefit at all unless they do their own work by going online and searching. This isn’t immediately clear in the press releases, but it should be noted as we consider how valuable these partnerships are for most patients.


Ultimately, we believe that PBMs, discount card partnerships, and copay assistance are all beneficial tools that help patients receive a more seamless experience in attaining the lowest cost for prescriptions in our crazy drug pricing world. That said, we further believe that the ultimate responsibility lies with helping the patient better understand options available to them and guiding them on how it impacts them individually. For example, according to IQVIA, nearly two-thirds of patients with commercial insurance or Medicare Part D paid the same or less when using a discount card instead of using their insurance. Some saved much more: 19% of Part D patients and 9% of commercially insured patients saved $20 or more with a discount card. Just looking at these stats highlights that the current PBM/discount card partnerships will only offer these benefits to fewer than 25% of the patients identified in the IQVIA study. So, despite these partnerships offering significant benefits to the patient, we at RxLink see plenty of opportunity to improve outcomes by also taking a patient-first approach and helping the patient understand how to better ‘play the cards’ alongside their specific coverage.