Insurance 101: Copay Cards
For more guides on healthcare costs and coverage, check out Health Insurance + Type 2 Diabetes.
If you live with diabetes, you’re probably looking for ways to reduce what you spend on your diabetes management, including insulin and other medications. Copay cards can be a helpful tool for saving you money at the pharmacy.
What is a copay card?
A copay card is a coupon typically offered by a drug manufacturer to lower your out-of-pocket costs on certain brand-name medications. They are sometimes called copay assistance cards or copay savings programs.
Many name-brand drugs, including most types of insulin, have copay cards available to patients. A copay card works to bring down the cost of the medication if you qualify.
How copay cards save you money
Copay cards apply savings to the cost of a medication, usually after your insurance covers a portion. With a copay card, the manufacturer covers all or a portion of the difference between your insurance copayment and the coupon price. Most of the time, the medication has to be covered by your insurance for you to be eligible to use the coupon.
Good to know: Depending on your insurance coverage, the amount you pay may be higher than the drug coupon’s advertised amount. That’s because copay cards usually have a maximum savings limit or a maximum number of times they can be used.
Copay cards aren’t useful for everyone or every drug. If your insurance copay is equal to or less than the advertised price on the copay coupon, you won’t get any additional savings.
Some manufacturers offer coupons that work with or without insurance. This is more common with brand-new medications. Manufacturers want people to use their new drug right away, so they make coupons widely available. These are typically offered for limited use only. For example, you might be eligible for the coupon price for 12 months only.
Depending on the medication and your insurance, the portion covered by the coupon may count toward your deductible. Though, that’s not always the case. Talk to your insurance provider to find out what you’ll pay out-of-pocket.
Where can I find copay cards?
To find a copay card or copay coupon, start with the drug manufacturer’s website. That’s where you’ll find the most accurate information on enrollment and any savings limits. You should always be able to enroll yourself, and copay assistance and coupon programs are always free to use.
Avoid organizations and individuals claiming to offer copay enrollment “services” for a fee. These services are never necessary! If you need help navigating enrollment in a copay card program, ask your healthcare provider or pharmacist for assistance. They often have savings resources, including coupons and handouts, that they get directly from drug manufacturers.
When you find a copay program, you’ll need to answer questions about your medication, where you live and your insurance coverage to make sure you qualify. You’ll then get a physical or digital copay card to keep.
How do I use a copay card?
Once you have your coupon, bring it with you to your pharmacy. Share the card with your insurance card when you meet with your pharmacist. They’ll tell you how much the copay card reduces your out-of-pocket costs.
More ways to save (including if you are uninsured)
Copay cards generally work with commercial insurance. If you don’t have insurance, or if you have Medicare or Medicaid, you likely won’t qualify for a copay card. But you may qualify for other types of payment assistance.
If you need help affording insulin, check out GetInsulin.org, a customizable tool that can help you find coupons and other savings programs you may qualify for, even if you don’t have insurance. You can also find information on what to do if you need an emergency supply of insulin.
Resources like GoodRx and SingleCare can help you find discounts on the list price of many medications. These coupons focus on generic medications and can help lower the retail price of medication if you don’t have insurance or your insurance doesn’t cover the medication you need.
People who are uninsured or underinsured can also take advantage of patient assistance programs (PAPs). These need-based programs are sometimes also called prescription assistance programs or medication assistance programs and are offered by pharmaceutical companies, state governments or nonprofit organizations to help people access their medications at low or no cost.
You may be required to answer questions about your diagnosis, income and any insurance you have. PAPs are not for people who have traditional commercial health insurance and can vary widely. Learn more about which PAPs you may qualify for at GetInsulin.org.
Copay card vs. co-insurance
A copay (or copayment) is different from co-insurance. Co-insurance is the percentage of a prescription, durable medical equipment (like an insulin pump) or service (like an MRI) you’re responsible to cover after you’ve met your deductible but separate from a copay. This is often required in hospital and specialty healthcare services and can also apply to brand-name medications on a higher tier of your insurance formulary.
Learn more about the differences between copay cards and other savings options with our Healthcare Glossary.
Are there any concerns about copay cards?
In a small study published in 2020, community pharmacists reported they generally feel good about copay cards’ ability to make medication more affordable for their patients. However, they were concerned about their patient’s ability to pay for their meds when the cards expired.
Healthcare advocates have raised the concern that copay cards artificially drive up prices. They can encourage patients and their healthcare providers to use higher-cost, brand-name drugs, in place of cheaper generic equivalents, meanwhile feeding high insurance premiums. The U.S. Department of Health and Human Services reported that if copay cards are used with federal insurance programs, like Medicare and Medicaid, they violate anti-kickback laws.
Talk with your healthcare team about the most affordable options for your medication.
