Medicare and Prescription Drug Coupons

[Pharmacy1999]

Recently, one of my techs pointed out that in the fine print of a lot manufacturer drug coupons, they exclude patients on "medicare or medicare part D". The question came up whether it would be illegal for someone with medicare but not part D to use the coupon. It does not make any sense to me that this would be the case, but does anyone know for sure?

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[Old Timer]

Recently, one of my techs pointed out that in the fine print of a lot manufacturer drug coupons, they exclude patients on "medicare or medicare part D". The question came up whether it would be illegal for someone with medicare but not part D to use the coupon. It does not make any sense to me that this would be the case, but does anyone know for sure?

That rule ONLY applies if the prescription was BILLED to Medicare or Medicaid. The purpose of the law is to prohibit enticements that would cause the government to spend money unnecessarily. So if they pay cash and use a coupon, it's fine.

 

[MountainPharmD]

That rule ONLY applies if the prescription was BILLED to Medicare or Medicaid. The purpose of the law is to prohibit enticements that would cause the government to spend money unnecessarily. So if they pay cash and use a coupon, it's fine.

I believe this incorrect. It clearly states if a patient HAS Medicare or Medicaid. A claim could always be paid for as a cash transaction and then submitted by the patient for reimbursement later. Besides I can think of very few manufacturer coupons someone would pay cash for rather than use insurance.

Didn't CVS just pay a big fine to the government because this?

 

[Ackj]

Besides I can think of very few manufacturer coupons someone would pay cash for rather than use insurance.

"Pay no more than $X" or "first fill is free" come to mind. I'll admit, those do usually have fine print where they need to be combined with some sort of insurance in order to waive the copay.

 

[Old Timer]

I believe this incorrect. It clearly states if a patient HAS Medicare or Medicaid. A claim could always be paid for as a cash transaction and then submitted by the patient for reimbursement later. Besides I can think of very few manufacturer coupons someone would pay cash for rather than use insurance.

Didn't CVS just pay a big fine to the government because this?

NO, they didn't. Only in your dreams. If the drug is not covered by Medicare, then they get X dollars off with some coupons. There are no Medicare plans that I am aware of that allow the patient to submit afterwards, I'm sure there is one in Walla Walla Washington, but it's not the norm and the average Medicare Part D member is not going to lay out several hundred dollars as all of the coupon drugs are expensive in order to save some money.

 

[Old Timer]

Old Timer- I get a lot of coupons for a first month free or other trial offer. We get a lot of Medicare patients wanting to use these offers, avoiding billing any other insurance entirely. It has been my impression that we cannot do this because they have Medicare, regardless of whether we are billing that particular prescription through Medicare. From what you posted, it seems like they could do this.

Does anyone know where legislation can be found on this topic?

Let's get a little history. Drug companies charge outrageous prices for medication. In response, insurance companies charge outrageous co pays & people refuse. Drug companies give coupons to mitigate the outrageous co pays while still getting the insurance to eat the cost of the outrageously priced drugs.

The government by regulation prohibits any inducement that would directly or indirectly cause the government to spend money. Hence these coupons are not permitted to be split billed with Medicare or Medicaid. This is still a free country and you can use the free one month trial coupons as long as there is no charge to the government.

 

[All4MyDaughter]

I'm looking at a Lantus coupon right now. It just says that it can't be used on claims paid by government programs. Rough paraphrase. I'm tired.

 

[UCIGUY]

theres a coupon for everything these days