Manufacturer's Discounts

Cons

• May require specific diagnosis codes - typically only for diabetes, not weight loss

• Administrative burden - paperwork and enrollment processes can be complex

• Doesn’t help with insurance premiums - only reduces copays, not overall insurance costs​​​​​​​​​​​​​​​​

• Not available for government insurance - Medicare, Medicaid, and other federal healthcare program beneficiaries are legally excluded

• Time-limited - most programs only last 1-2 years, after which patients face full costs

• Creates dependency - patients may struggle when the savings period ends

• Doesn’t address underlying drug pricing - manufacturers can keep list prices high while offering selective discounts

• May not count toward deductibles - copay assistance often doesn’t help patients meet their annual deductibles

• Can be discontinued at any time - manufacturers can change or eliminate programs without notice

• Eligibility restrictions - must have commercial insurance; uninsured patients typically don’t qualify for copay cards

• Income limits - some programs have maximum income thresholds that exclude higher earners

• Requires reapplication - often need to renew annually or periodically

• Pharmacy restrictions - some programs only work at certain pharmacies

• Insurance plan exclusions - some insurance plans don’t accept manufacturer coupons

• Privacy concerns - requires sharing personal and medical information with pharmaceutical companies

• Creates market distortion - encourages use of branded drugs over potentially cheaper alternatives

Pros

• Can significantly reduce out-of-pocket costs for patients, sometimes to as low as $25-$50 per month instead of $900-$1,300

• Provide access to expensive medications for patients who might otherwise be unable to afford them

• Usually easy to apply for online or through healthcare providers

• May bridge the gap while waiting for insurance approval or appeals

• Dependent upon the discount plan, income verification may or may NOT be required

• Can cover copays for commercially insured patients

• Can be used relatively quickly once approved