Good RX and Medicare

How Does GoodRx Work With Medicare?

The complexity of the American healthcare system is well-known, especially when it comes to obtaining prescription medications, which can be confusing and expensive. GoodRx offers consumers a solution by striving to increase transparency in drug pricing and providing discounts on prescription medications. However, what are the advantages and disadvantages of
using GoodRx, and how does it interact with insurance plans, such as Medicare?

What is GoodRx?

Established in 2011, GoodRx is a website and mobile application accessible to consumers at no charge, offering a platform that monitors prescription drug prices and furnishes coupons for discounts on medications. It is important to note that GoodRx functions independently of traditional insurance programs such as Medicare.

Doug Hirsch, co-founder, and chief mission officer of GoodRx, was inspired to create the company after facing a prescription dilemma. He received a medication prescription priced at approximately $500 from his regular pharmacy. Seeking alternatives, he discovered varying prices, with one pharmacy quoting $250 and another $400 for what he presumed to be an
inexpensive generic drug.

When he declined to make the purchase due to the high cost and left the pharmacy without the medication, the pharmacist pursued him into the parking lot, expressing a desire to assist him in obtaining the necessary medicine. “I started by accident to find out there were these drug discounts that would enable someone who’s purchasing a drug to get it for much, much less,”
he says.

How Does GoodRx Work?

Utilizing GoodRx enables you to conveniently obtain discounts to alleviate the expenses associated with prescription medications. GoodRx achieves this by establishing partnerships with pharmaceutical manufacturers and pharmacy benefit managers (PBMs). According to Hirsch, PBMs function akin to the “Ticketmaster of health care,” negotiating with pharmacies to
establish prices and copays for medications on behalf of insurance companies and employers.

“We’re sort of Switzerland in the middle of trying to work on behalf of the consumer,” Hirsch explains, adding that GoodRx brings together all the various discount programs to find which is the best one for you. “There’s tremendous savings, and often you’ll pay less than you would pay with a copay, or certainly if insurance doesn’t cover it.” Since it launched, Hirsch says, the company has saved Americans upward of $70 billion.

Using GoodRx

When you search for a specific medication in the app or on the website, you’ll be presented with a list of nearby pharmacies and exactly what they are charging for that prescription. GoodRx currently works at more than 70,000 pharmacies across the United States. Hirsch also notes that GoodRx discounts medications that may be dispensed for your pet from a regular human pharmacy. Pets don’t qualify for Medicare or human health insurance plans, obviously, but their health care expenses can add up quickly.

What Is Medicare Part D?

Medicare, the federal health insurance program tailored for individuals aged 65 and older, along with some younger individuals with disabilities, consists of various components. Among them, Medicare Part D stands as an optional benefit provided by private insurance companies, aiming to cover certain prescription drug costs, either partially or entirely.

Each Part D plan maintains its own formulary, delineating the medications covered, subject to potential yearly modifications. Consequently, prices and benefits can fluctuate depending on your specific coverage. Thus, it is imperative to review the formulary of any Medicare Part D plan you consider purchasing during the annual enrollment period, ensuring that your required
medications are included.

Whitney Stidom, vice president of Medicare operations at eHealth Inc., headquartered in Santa Clara, California, advocates for seniors to acquire Part D coverage. “Everyone on Medicare needs prescription drug coverage,” she points out. “It’s no secret that prescription drugs can be costly, especially without insurance. As a Medicare beneficiary, enrolling in drug coverage is one
of the best things you can do to shield yourself from medical expenses.”

Do GoodRx and Medicare Part D Work Together?

GoodRx and Medicare can work together. However, you do not need to use both your Medicare card and GoodRx. “You use one or the other, but most pharmacists are happy to look at both prices and give you the cheaper one,” Hirsch notes.

GoodRx can help with Medicare coverage gaps

If a medication you need isn’t covered by Part D, you’ll have to pay for it out of pocket, which can get expensive. GoodRx, however, can often reduce the cost if you’re prescribed a medication that’s not included in your coverage plan.

GoodRx can also help reduce costs when you’re in the coverage gap phase, sometimes called the donut hole, of your Medicare plan. That’s the period when you and your drug plan have spent a certain amount for covered drugs. In 2024, that gap starts after you and your plan have spent $5,030 on covered drugs. When you enter the coverage gap, you’ll qualify for a discounted rate to buy prescriptions at the pharmacy or order them through the mail. GoodRx can further reduce those costs.

You can submit claims to your Medicare plan to get credit for spending that’s occurred via GoodRx if you’re trying to meet a certain deductible. You can also use the GoodRx app or website during your annual enrollment period to research drug prices, which may help you make the best selection of Part D plans available to you.