High-Deductible Health Plans Mean More Cash-Paying Customers for Prescriptions: Here’s How to Find a Cash Solution That Works

Seeing more cash-paying customers at your counter? This scenario may be on the uptick as more employers offer high-deductible health plans (HDHPs). As patients continue to look for savvy ways to save money on their prescriptions, community pharmacists need to be ready with a cash-price solution that keeps price-sensitive customers happy without hurting the bottom line. Here’s what to look for in a cash-pricing solution.

HDHPs are on the rise and customers are looking for alternative payment methods.

A recent analysis found a 13% increase in people on HDHPs in recent years. That means more pharmacy customers are paying attention to cash prices of their medications. An HDHP is treated as a distinct health plan in which more costs are paid out-of-pocket (the deductible) before the plan starts to cover eligible costs. The IRS sets minimum deductibles to define an HDHP; the minimum deductible in 2022 is $1400 for an individual and $2800 for a family.

And yet studies have shown that actual deductibles can regularly be more than $4500 for a family—significantly exceeding those minimums.

The rise of HDHPs could increase the need for a solution for cash-paying customers. A recent survey on consumer attitudes toward prescription medication found that 57% of respondents had asked for the cash price at the pharmacy counter—even though they had insurance. And even with that insurance, 66% of respondents thought they paid too much. Clearly, customers are likely looking for ways to save money, and that could mean paying with cash or popular savings cards.

Cash cards and coupons can hurt the pharmacy bottom line.

Many patients have likely turned to popular prescription savings cards, such as GoodRx, to offset the high cost of drugs and their deductibles. But as so many pharmacists know, these cards can hurt business.

Many cash card programs charge a processing fee, which can take a big bite out of pharmacy profits, particularly for smaller, independent shops. And as some pharmacists and pharmacy owners pointed out in 2021, when Surescripts and GoodRx announced a partnership, coupon programs “allow PBMs (pharmacy benefit managers) to enter the cash-paying market,” working within a system that has been accused of obscuring the real cost of drugs.

Taking the guesswork out of cash pricing will help pharmacies succeed.

But how to find a solution that works for you and your customers? Look for the following attributes:

• Transparent fees, below $1 per transaction/claim, charged only for paid claims with no additional reversal or hidden costs for the pharmacist.
• Predictability through guarantees or risk minimization.
• A sustainable model that provides competitive pricing for patients while preserving pharmacy profitability.
• Security for patient data through technologies such as blockchain.

As consumers continue to look for ways to save money on their prescriptions and shop for alternative ways to pay, it’s essential that pharmacists have a cash-pricing solution. It’s just one more way that pharmacies can engage customers, win over new ones, stay profitable, and continue to provide the essential community support that only trusted pharmacists can offer.

About the Author

Paige Clark, RPh, is the VP of Pharmacy Programs and Policy at Prescryptive, overseeing the company’s policy work to drive awareness, utilization, and scope of trusted independent pharmacists nationally. Prior to Prescryptive, Paige spent 11 years at Oregon State University's College of Pharmacy, driving policy initiatives for the state’s licensed pharmacists, including the prescribing of birth control and tobacco cessation services. Paige also worked as the Staff Pharmacist Consultant for the Oregon Board of Pharmacy, managing rule writing, legislative endeavors, and regional and national policy work. She is a frequent speaker and presenter at national industry conferences and a multi-award winner, including several Pharmacist of the Year recognitions.

Sources

High-Deductible Health Plans Continue to Grow in Popularity, but Are They Right for You?, Value Penguin by Lending Tree, accessed March 17, 2022.

What are HDHPs & HSAs?, Healthcare.gov, accessed March 17, 2022.

2020 Employer Health Benefits Survey, kff.org, accessed March 23, 2022.

High-Deductible Health Plans and Access to Prescription Medications, PAN Foundation, accessed March 17, 2022.

Consumers in Pain Over High Prescription Prices, Ready to Take Action and in Need of Better Tools, According to Survey by Scripta Insights, PRNewswire.com, accessed March 17, 2022.

Independent pharmacists sound the alarm on Surescripts, GoodRx partnership, mobihealthnews.com, accessed March 17, 2022.

Copy of letter to Surescripts Boardmembers, medcitynews.com, accessed March 17, 2022.