If you feel confused about how much you pay for your hypothyroidism treatment, you're not alone. Retail prices, copay prices, and coupon prices can all be so complicated, and many people end up paying too much.
Research even shows that half of all patients are overpaying for their thyroid medication!
Ahead, an in-depth look at how manufacturer copay cards and direct purchase programs can help you save on your thyroid medications, including levothyroxine (synthetic T4/thyroxine), liothyronine (synthetic T3/triiodothyronine), and natural desiccated thyroid drugs (abbreviated as NDT, also known as thyroid extract.)
The cost of thyroid drugs
There are three categories of prices for your thyroid medications: retail cash price, insurance copayment price, and direct purchase price.
Retail cash price
First, the retail cash price is what you pay at a pharmacy if you are uninsured or not using your insurance. The retail price is less than the "list price" the manufacturer sets for a drug.
When it comes to a retail cash price, we can further break it down into two different retail prices:
- The retail cash price you pay without using any discounts
- The discounted retail price after taking advantage of outside coupons and discount programs. (By the way, before you pay retail for any prescription medication, you should always compare prices and search for discounts using a free service like GoodRx or SingleCare.)
Insurance copayment price
Second, there's the insurance copayment price (known as the "copay"). That's the amount you pay for a drug if your health plan covers the drug on its formulary. A formulary is a list of medications your health plan has approved for coverage.
Each health plan assigns a drug to a particular copay tier based on a drug's manufacturer list price and other factors. Inexpensive generics are at lower copay tiers, and more costly brand-name drugs are in higher copay tiers.
Here's what a typical three- or four-tier copayment formulary looks like, along with the average copay amounts:
- Tier 1 drugs typically include lower-priced generic medications and inexpensive brands. According to the Kaiser Family Foundation, the typical copay for a Tier 1 drug is around $11.
- Tier 2 drugs include generic medications with higher list prices and some brand name medications that your health plan labels as "preferred" brands. The typical copay is $33.
- Tier 3 typically includes preferred and non-preferred brand name medications with higher list prices. Your health plan may also categorize a drug as Tier 3 if there's a similar drug available at a lower price. The typical copay is $59.
- Some health plans also have a Tier 4, which typically includes non-preferred brands, drugs with high list prices, and specialty drugs for rare medical conditions. The typical company is $105.
Different health plans can assign the same drug to a different tier to complicate things a bit, as you'll see in the following graphic showing the copay tiers for medications used to treat hypothyroidism.
Direct purchase price
Third, some manufacturers set a direct purchase price. This price is what you pay for your medication when you purchase it directly from a manufacturer-designated mail order pharmacy.
How to save on brand name levothyroxine drugs
If you take a brand name levothyroxine drug like Levoxyl®, Synthroid®, Tirosint®, Tirosint®-SOL, or Unithroid®, one of the best ways to save on the cost of your medication is to utilize manufacturer copay cards and direct purchase programs.
A copay card (sometimes called a copay coupon) is a special discount card offered by a drug manufacturer that reduces your insurance copay and lowers your out-of-pocket payment. When you use a manufacturer copay card, you pay either a percentage off or a fixed amount for your prescription. Either way, you pay less than your copay amount.
With a direct purchase program, you fill your prescription with a designated mail order pharmacy that sources medication directly from the manufacturer. This process bypasses the middlemen and passes the cost savings along to you.
Here's a rundown of your saving options for brand name levothyroxine drugs.
Levoxyl® Copay Cards
The retail cash price for Levoxyl® averages $35 per month without a discount or around $20 per month with outside discounts. As a Tier 1 or 2 drug, the company ranges from $11 to $33 a month.
Pfizer, the manufacturer of Levoxyl® brand levothyroxine tablets, has a copay card for patients with insurance. The estimated savings for Levoxyl® using the card ranges from 36% to 75% off the retail cash price, depending on the quantity purchased and the pharmacy where it's purchased.
Synthroid® Copay Card and Synthroid® Direct
The retail cash price for Synthroid® brand levothyroxine tablets averages $55 per month without a discount and $45 per month with outside discounts. As a Tier 2 or 3 drug, the company ranges from $33 to $59 per month.
Synthroid® manufacturer AbbVie has set up the "Before Breakfast Club" to provide copay cards to insured patients. According to AbbVie, most patients with insurance pay no more than a $25 copay for a one-month supply of Synthroid using their copay card.
Synthroid® also offers the Synthroid Direct Enrollment program through Eagle Pharmacy. In most cases, you can get your Synthroid® prescription filled by mail for $25 a month -- with or without insurance.
Tirosint®/Tirosint®-SOL Copay Card and Tirosint® Direct
Tirosint® is a dye-free form of levothyroxine that comes in gel capsules. Tirosint®-SOL is a dye-free levothyroxine oral solution.
Because of their unique manufacturing process and form, these drugs have a high retail cash price of around $165 per month without a discount, and $130 per month with outside discounts. Some commercially-insured patients face higher Tier 3 and Tier 4 copays for Tirosint®.
The manufacturer, IBSA, offers a Tirosint® copay card you can use at any retail pharmacy to save up to $105 per month off the copay for Tirosint® or Tirosint®-SOL. According to IBSA, 90% of commercially-insured patients pay as little as $25 for a one-month supply when using the copay card.
You can also fill your prescription using Tirosint® Direct. Under the program, you can order a one- or three-month supply of Tirosint® capsules or Tirosint®-SOL oral solution from one of IBSA's network of designated mail-order pharmacies.
If you have insurance, in most cases, you usually pay no more than $25 a month. If you don't have insurance or your copay is still high even with discounts, you have the option to pay the program's cash price of $50 per month, or $120 for a three-month supply ($40 per month).
Find information on Tirosint® Direct on the Tirosint® website.
Unithroid® Copay Card
Unithroid® brand levothyroxine tablets have a retail cash price of around $20 a month without a discount and $11 a month with outside discounts.
For those with insurance, Unithroid® distributor Amneal offers a copay card. According to Amneal, with the Unithroid® copay card, more than 90% of commercially-insured patients pay as little as $3 for a one-month supply.
Reminders about copay cards
While drug manufacturer copay cards can save you money, here are some crucial points to remember:
- In most cases, you need to sign up in advance and show your copay card at the pharmacy every time you refill a prescription.
- Copay cards frequently have a monthly or annual maximum amount you can save – or a maximum number of times you can use the card - so find out the terms upfront.
- Some copay cards expire, so check for an expiration date. You also may be able to reapply after expiration.
- Some health plans do not count your copay toward your annual deductible when you use a copay card. Some plans apply only the discounted copay amount. Check with your health plan for details.
- California severely restricts the use of copay cards. A copay card doesn't apply if there is a generic version of a drug available. (This means that you can't use copay cards for brand name levothyroxine tablets unless your doctor specifies that the brand is medically required and your health plan exempts you. Because there is no generic equivalent for levothyroxine capsules and oral solution, you can use a Tirosint®/Tirosint®-SOL copay card in California.)
- Copay cards are not valid for use if your coverage is government-sponsored, for example, Medicare, Medicaid, the Veteran's Administration, or Department of Defense/Tricare.
- Finally, there currently aren't any manufacturer-sponsored copay cards for brand name natural desiccated thyroid drugs or liothyronine.
Is the retail price less than your copay?
There are times when your insurance copay, even when using a copay card and all available discounts, is still higher than the lowest retail cash price. You may not be aware of this unless you ask the pharmacist up front, because some states do not require a pharmacy to volunteer the fact that your medication would cost less if you pay retail and bypass your health insurance.
Pharamacists are required to give you this information if you ask. So, make it a habit always to ask: "Which is lower: the discounted retail cash price, or my copay amount?" That way, you have the option to pay the lower price, and pocket the savings.