Does the Optum Perks Discount Card help with copayments?

Optum Perks is a prescription drug discount program that helps you find lower prices for certain prescription medications. Companies offering these discounts negotiate with pharmaceutical companies and pharmacies to lower the costs of medications.

These cards are usually free, and you can often use them at multiple major pharmacies and retail stores. The Optum Perks Discount Card can provide up to 80% savings on the price of certain prescription medications. 

How does the Optum Perks Discount Card work?

Optum Perks negotiates directly with pharmacies and companies to offer the best price for medications. You can use the discount card itself or search the Optum Perks site for a specific drug discount.

Depending on coupons and discounts available, the amount you can save can vary. For example, the drug semaglutide (Ozempic), which the FDA approves for managing type 2 diabetes, is around $910 using an Optum Perks discount coupon. Semaglutide (Ozempic) is typically a tier 3 medication and can sometimes cost around $1,100 without insurance. The FDA does not currently approve Ozempic for weight loss.

You can visit the Optum Perks website to download the free discount card or coupon.

Can you use it alongside insurance? 

You can still use your Optum Perks Discount Card if you have a health insurance plan. But you cannot use them both together. 

If you have health insurance, you may only pay a small copayment toward the cost of medications. If you use your insurance, anything you pay will go toward your out-of-pocket maximum. However, if the drug a doctor prescribes is not on an insurer’s formulary (list of drugs an insurer covers), you may find using a discount coupon or card beneficial.

You can compare the cost of your copayment to the discount you will receive through an Optum Perks Discount Card to check which will save you the most money.

You can use money from a Health Savings Account (HSA), Flexible Spending Account (FSA), or Health Reimbursement Arrangements (HRA) alongside an Optum Perks Discount Card or coupon.

Can I reduce my prescription copayment?

Insurance providers usually fix copayments, which are usually nonnegotiable. Insurers base copays on their formularies, which are divided into tiers and generally based on medication costs. The lower the medication cost, the lower the tier and associated copay. Insurance plans can have up to five tiers for prescription medications.

Although copays are often fixed amounts, comparing the price of your copay to the cost of a coupon or prescription discount card may save you money.

However, if you choose to use a discount card or coupon, the money cannot count toward your out-of-pocket maximum. If you use your insurance, all of the payments will apply to your out-of-pocket maximum, and after this amount, your insurance plan will usually pay 100% of your eligible healthcare costs.

Checking your prescription drug coverage with your insurer 

If you have an insurance plan, your insurer usually covers all or part of the cost of medications. Insurance plans have a list of prescription drugs covered by an insurance plan, called a formulary.

You can check your plan’s formulary and see if the medication you need is covered and under which tier. The tiers are divided mostly on cost — the lowest tier generally comprises generic drug versions and lowest-cost medications.

Each insurance plan has its own formulary or drug list, with set copays for each tier. You can contact a plan provider to discuss the drugs it covers and associated out-of-pocket costs, as it will differ from company to company.

Summary

The Optum Perks Discount Card can help you save money on prescription medications.

However, it’s important to keep in mind that insurance plans cover these medications for specific uses. For example, in the case of Ozempic, it’s only covered when used to treat type 2 diabetes and not for other purposes, like weight loss.

You can still use prescription discount cards if you have an insurance plan but cannot use them together. To get the best price for a medication, such as semaglutide (Ozempic), you can research your insurance plan coverage for medications it covers and compare that with the discounts and coupons a prescription discount card offers.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.