Copay Card (Copay Coupon)
A manufacturer-provided discount card that reduces or eliminates a patient's out-of-pocket copay for a brand-name drug — effectively making the drug free for patients with commercial insurance.
How It Works
Copay cards are a controversial marketing tool. Manufacturers offer them to reduce patients' copays to $0-25 per fill, even for drugs that cost thousands. This encourages patients to stay on expensive brand-name drugs rather than switching to cheaper generic or formulary alternatives. The insurer still pays the high negotiated price, driving up premiums for everyone. Copay cards are prohibited for Medicare and Medicaid patients (using them is considered a federal kickback violation). Copay accumulators and copay maximizers are insurer strategies designed to counteract copay cards by not counting manufacturer payments toward the patient's deductible or out-of-pocket maximum.
Related Terms
- Out-of-Pocket Cost — The amount a patient pays directly for a prescription drug — including copays, coinsurance, and deductible payments.
- Patient Assistance Program (PAP) — A manufacturer-sponsored program that provides free or discounted drugs to patients who meet income and insurance eligibility requirements.
- Formulary — A list of prescription drugs covered by an insurance plan, organized into tiers that determine how much the patient pays for each drug.
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About This Definition
This definition is part of the DrugPrice Drug Pricing Glossary — 34 terms explaining how prescription drug pricing works in the United States. All definitions are written in plain language for patients, caregivers, journalists, and healthcare professionals.