5 Tips for Pharmacy Coupon Billing

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Nov 11, 2015 9:22:10 AM

Pharmacy Coupon

I’m sure that you’ve come across a pharmacy coupon in the course of your work that has been a challenge. Coupon cards have a tendency to put a hitch in your normal pharmacy workflow, and may cause you to make mistakes. For example, forgetting to bill a coupon or billing it incorrectly. This can force you to resubmit the claim, which costs you time and another switching fee charge, not to mention the impact on the customer experience.

5 Tips for Pharmacy Coupon Billing

To help combat problems that commonly occur with coupons we’ve come up with five tips to help your pharmacy bill coupons effectively.

Review Copay History

You should always review the patient’s copay history prior to submitting a manufacturer’s coupon. This will help you verify that the copay of the coupon is not more than the copay of the patient’s insurance. You don’t want to inadvertently charge the patient more when they were attempting to save money.

Rarely will you ever see a copay reducing coupon give a higher copay than the primary. If the copay is higher than expected or advertised, make sure to read the terms and conditions to see if there is a max amount they will pay.Crestor Coupon Disclosures

For example, your primary insurance left a $100 copay and the coupon states the customer will pay "as little as $18 a month*", but has a max of $50 then it will only reduce the copay to $50.

Also, reviewing copay history lets you know if the savings on a copay assistance card will exceed the insurance copay. It’s important to let your patients know that the savings amount will never exceed their out-of-pocket cost. Therefore, they will never receive any money back at the checkout, even if their coupon is for $15 off their copay but their copay is only $10.

Find Coupons Beforehand

 Don’t wait for your patient to bring a coupon to you. You can go online and find coupons for your patients at drug or manufacturer sites. Also, be sure to ask your patients if their doctor provided them a coupon during their visit. Their physician may have manufacturer coupons that you simply don’t have access to.

Be sure when searching for and taking coupons that you know which coupon card is which.  

Amoxicillin Discount Card

Discount cards often give a percentage off of the retail price of a medication and are intended to be used without insurance.

Crestor Coupon Card

Copay assistance remove a dollar amount from the copay the patient is expected to pay with their insurance. 

If you let patients know coupons may be available and your pharmacy is happy to take them, it can distinguish you from other pharmacies that don't accept them or choose not to address them with the patient.

Manufacturer’s Coupons

When manufacturer reps come into your pharmacy they always have questions for you regarding a specific doctor’s prescribing habits or may want to introduce you to new medications. You, like most other pharmacy owners, may not have much of interest to discuss with them.

However, take this time to request manufacturer’s coupons for your patients and a complete lineup of medication that they represent. This not only builds your relationship with your manufacturer rep, it also builds your relationship with your patients through copay assistance.


It’s becoming popular that coupons are no longer paper. Instead, they’re transitioning to electronic forms through your third-party claims service. With electronic prescription vouchers you don’t have to locate coupons.

When you send the transmission through your claims company, they will locate a coupon in the cloud and apply it to that prescription before sending it to the insurance company. Both RelayHealth and Emdeon offer this service by contracting with the drug manufacturers to lower patient copays and improve patient outcomes.

Utilize Pharmacy Software Tools

Most pharmacy software programs have smart coupon billing, allowing you to set up the coupon as an insurance company or payer type and enter important fields: coupon expiration date, NDC or NDC range and whether refill assistance is available or not.

This allows you to input the coupon once and use it again on any available refills they may have. Also, your software may have the ability to help with automating the secondary billing of this coupon so it is never forgotten.


When using these tips you must also take time to set the expectation for your patients. You may know that their coupon is only good for three refills, but they may not. You should educate the patient on all the “fine print” that comes with their coupon. Also, research and counsel them on generic options that may be better for them in the long run.

Communicating with your patient helps build a trusting relationship and will keep them coming back to your pharmacy for their health care needs. Imagine the experience if they transferred to a different pharmacy and didn’t receive the same low copay they have come to expect from your pharmacy. Coupon billing techniques are directly tied to patient satisfaction.

If you’d like to learn about how Computer-Rx has made billing coupons within our software simple, click below!

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