Thread by @sweetchinchilla

As promised, a 🧵 on GoodRx.

Starting off with the basics…

What is it?
GoodRx is a prescription drug price tracking and discount company. It’s essentially another middle man in the messy landscape that is #drugpricing in the US.

But it’s more complicated than that… #TwitteRx

GoodRx is best known for their coupons. They track prescription drug prices and offer patients a discounted price, which varies a bit based on which pharmacy you select.

Here’s an example of what a search for enalapril looks like…
2/17

GoodRx coupons CANNOT be combined with insurance. ❌

Now, this *might* be helpful for a patient who is completely uninsured, or someone on relatively few inexpensive meds who never hits their deductible anyway, but even then, if you ask your pharmacist for a cash price instead…

You may be surprised to find the cash price they’re able to offer is about the same, and avoids a middleman skimming both money and your personal information off of that transaction.

Ask your pharmacist first for their cash price, or if they are able to price match w/o a coupon.

If you *do* have prescription drug insurance and use GoodRx instead, keep in mind the amount you pay is NOT counting toward your deductible. (The same is true if you choose to pay the cash price for a prescription.)
5/17

Clarification: When we say “cash price” in pharmacy, it is NOT like the gas station⛽️. A cash price just means we don’t have to run the transaction through an insurance plan or copay card. It’s not referring to whether you pay in cash 💵 or with debit/credit cards 💳.
6/17

We’ll circle back to the coupons and what’s happening behind-the-scenes (and how PBMs are involved), but first let’s look at a couple other things GoodRx is doing lately…
7/17

GoodRx now has a subscription service, GoodRx Gold, and also facilitates the Kroger Rx Savings Club, which also offers discounted telehealth services (which IDK much about so won’t comment on in this 🧵) and steers patients to a mail-order pharmacy.
8/17
cnbc.com/2021/09/24/goo…

In the past year, GoodRx has been buying up the competition…
9/17
bloomberg.com/news/articles/…

… and forming relationships that may lead to GoodRx prices getting embedded into EMRs at the point of prescribing.
10/17
medcitynews.com/2021/08/goodrx…

If that sounds like a move toward transparency, it’s not. GoodRx shows an inflated base price to make their discounts seems more impressive. This also benefits PBMs (and I promise we are coming back to them soon).
11/17

With integration into EMRs, we should expect to see more patient steering (i.e. more driving patients away from small regional or independent pharmacies and into the PBM’s vertically integrated chains / mail order), and more fractionated pharmacy care, by prompting prescribers…

… to send different prescriptions to different pharmacies, chasing the “lowest price” (according to GoodRx), and bypassing some of the safety checks that come with having one pharmacy (ex. screening for drug-drug interactions or duplicate therapies).
13/17

Okay, so how are PBMs involved??? This post nails it: drugchannels.net/2021/08/why-go…. 🔨
14/17

“Unlike many of its discount card peers, GoodRx partners with multiple PBMs, including Express Scripts, OptumRx, MedImpact, and Navitus. These PBMs compete on the GoodRx platform to acquire prescriptions.”
15/17
drugchannels.net/2021/08/why-go…

GoodRx keeps PBM’s cash rates anonymous, allowing PBMs to offer lower prices to coupon customers and charge an inflated price to plan sponsors (i.e. health plans or small business, THEIR CLIENTS, who are literally paying them to negotiate best prices).
16/
drugchannels.net/2021/08/why-go…

TL;DR - GoodRx is another middleman in our broken, for profit health insurance system.

Short-term, on an individual level, coupons may be helpful for patients who are uninsured or low utilizers of their prescription drug benefits. But ask your pharmacist for a cash price first!