Hacker News Reader

Comment by sam36 | Hacker News Reader

I don't think that is the full truth. Everyone in the industry seems to see goodrx as dishonest and they all state the same story similar to this recent one from reddit[0].

In my personal experience, the goodrx "coupon" for my drug was $30. Sure enough, at the pharmacy, I was charged $30. But if I use the same coupon the next month, the price is magically $57. I could print out a new coupon every time, but the process with the pharm tech to change to a different "drug card" (which is what they see it as) is nearly a 5 minute process. By contrast, my state offers their own group drug card, and the charge is usually around $45. It might go up or down by a few dollars every 6 months, but that is it.

[0]: https://www.reddit.com/r/explainlikeimfive/comments/ih4ziy/e...

View on HN

That comment does not understand how pharmacies get paid. The patient pay amount is irrelevant to how much the pharmacy makes. Pharmacies make money from prescription dispensing fees, which are generally around 1-2 dollars. PBMs are the ones that make money on patient pay amounts and are the same ones that pay the wholesalers, and they have different payout contracts depending on which card is being used. GoodRx relies on these PBMs for business, who have done the math on the arbitrage being in their favor. Source: I worked at a GoodRX competitor a couple years ago.

I worked with PBMs in the past and it's more than just the dispensing fee.

Typically a pharmacy will enter into a contract with a PBM and the PBM will reimburse the pharmacy for each drug at a set amount. That amount does include a dispensing fee, but the pharmacy can also make money off the margin between acquisition and reimbursement.

So if a months supply costs the pharmacy $30.

The PBM might pay $23 for the drug, $2 dispensing fee and tells the pharmacy to collect a $10 co-pay ($35 total).

Pharmacy makes $5.

However, what I've heard is that it's never that simple. PBMs are constantly trying to pay as close to acquisition cost as possible and when you have multi-source drugs (generics), they often just pay the lowest price.

So I've heard from pharmacies that some drugs have a 50% margin and other have a -20% margin. The PBM tells them it "all evens out" which is BS. The PBMs also have DIR fees, where a couple quarters later they claw back additional money, again arguing that the prior reimbursement was too high. The PBM model is really trying to squeeze pharmacy margins as much as they can.

The drug price changed, independent of your usage of the coupon. In my experience, I have used GoodRx for years and paid the same price always.

I’ve seen ca. 6-month price changes, and a complete reordering of the price ranking among pharmacies. Just go to the new pharmacy and have them transfer the Rx.

This is standard pharmacy behavior. Has nothing to do with GoodRx, which is an advertiser. Pharmacies determine all prices. Different pharmacies have different loss leaders each month. You go to the GoodRx “best” price pharmacy with your bottle. That pharmacist will take care of the transfer, using the RX# and possibly calling the Dr. I will always do the legwork, to me it is a “dollar vote.”

That comment doesn't appear to explain anything about GoodRX changing their prices. It's ranting about how pharmacies lose money on the coupons, but I don't think that's how drug pricing works. If a pharmacy has a $100 drug and the coupon brings it down to $80, nobody "lost" $20.

Reply on news.ycombinator.com