Dive Brief:
- GoodRx has notched a third partnership with a pharmacy benefit manager to integrate its drug coupons at the point of sale, further expanding GoodRx’s access to the commercially insured PBM market.
- For eligible members filling a generic medication starting in 2024, the new program will compare GoodRx’s discount price with their price through insurance and apply the lowest cost. The payment will be automatically applied to consumers’ deductibles.
- With MedImpact and existing deals with CVS Caremark and Cigna-owned Express Scripts, GoodRx now reaches more than 60% of insured lives through the partnerships, the company said Wednesday.
Dive Insight:
GoodRx first partnered with Express Scripts late last year in the first of the California-based digital health company’s deals with PBMs to expand access to its drug discount coupons.
GoodRx has been piloting the partnership with Express Scripts throughout this year, and plans to fully roll it out in 2024. Meanwhile, GoodRx announced the Caremark partnership earlier this summer, and is expected to begin piloting in 2024, with a full roll out in 2025.
MedImpact is a small fish compared to Caremark and Express Scripts. Express Scripts and Caremark alone are estimated to control roughly 59% of all U.S. script volumes, while MedImpact controls less than 3%, according to J.P. Morgan analyst Lisa Gill.
Analysts expect GoodRx to continue pursuing the PBM deals, which promise to significantly expand the scope of users with easy access to its coupons.
The company is paid through contracts with PBMs, either with a paid percentage of fees that PBMs charge to the pharmacy, or a fixed amount for every prescription that’s filled originating from its discounted pricing.
GoodRx is generally paid more if its discount cards generate a higher volume of prescriptions over a payment period. The company has pursued a number of new avenues to connect patients to its coupons, including a drug cost estimation tool for providers.
These partnerships can also be beneficial for PBMs. Giving patients access to lower discount card pricing means more prescription activity occurs inside the pharmacy benefit, resulting in a more complete claims record for beneficiaries. As for plan sponsors, the deals could reduce benefit costs when patients use GoodRx’s lower price, T.D. Cowen analyst Charles Rhyee noted.
PBMs may also be creating a new fee stream. In GoodRx’s deal with ExpressScripts, the company pays a marketing fee to the PBM since it’s acting as a distribution partner, according to DrugChannels.net.
It’s unclear whether the same arrangement is in place with the CVS and MedImpact deals. A spokesperson for GoodRx declined to share detailed financial terms of the partnerships.
Consumers at the pharmacy counter are often surprised when the price negotiated by their health insurer is more expensive than paying with cash or swiping a discount card.
PBMs, which negotiate prices with drugmakers and oversee pharmacy benefits for payers, have found themselves at the center of criticism over rising drug costs in the U.S. Congress is currently considering a number of proposals to reform the PBM industry.
Late last week, the Republican-led House Energy and Commerce, Ways and Means, and Education and the Workforce committees officially released healthcare transparency legislation that would force PBMs to disclose data on prescription drug spending to employers.
