Green Pill Pack

11/29/2023 | Expert Insight

Market Analysis: PBMs should be Leveraging Cash Pay and Lower-cost Pharmacy Trends

Author: Nate Bullock – Pharmacy Services Manager





Even Consumers with Insurance want to Pay Cash, when the Price is Right

Consumers who have health insurance are increasingly paying cash for their prescriptions, instead of running the drug claim through their prescription coverage. In fact, 61% of consumers say they have paid cash at the pharmacy for prescriptions, despite having insurance.1

Because of this trend, Pharmacy Benefit Managers (PBMs) should make it easy for consumers who want to cash pay. This opportunity not only increases consumer satisfaction among those who prefer cash pay, but also saves money for health plan payers.

PBMs, then, need a strategy that includes cash pay discounts, such as GoodRx®, other cash pay options (e.g., Amazon® RxPass), and low-cost pharmacies that accept insurance such as Mark Cuban Cost Plus Drug Company, PBC (Cost Plus Drugs) and Amazon Pharmacy, embedded into the member’s experience. Incorporating a point-of-sale partner, such as CoverMyMeds®, is also critical, so members can have a cash pay option (if they want it) at the purchase point, without the hassle of researching (i.e., is cash pay cheaper for me or is using insurance less expensive in this situation) themselves.

Cash Pay Discounts

Patients with commercial insurance are the highest utilizers of cash pay discount programs with 24% utilization.2

PBMs who serve members with commercial insurance should take note, and make it easy for these populations to access discount programs, and lower cash pay options. PBMs should seek connections to multiple discount options, especially ones that have good brand recognition that consumers trust (e.g., GoodRx).


One strategy Scripius has employed is to embed discount options in the member’s online account. When a member is searching for a drug or looking at cost options, they can click on discounts or use options from recognized brands inside their member account. If the consumer likes the price, they can digitally apply the discount or print it out and use it at the pharmacy.

Simple steps that make it easy for consumers to find discounts inside their digital member experience can help increase utilization of cash pay. Increased utilization can drive down costs for the health plans and plan sponsors that PBMs serve.

Cash Pay at the Point of Sale

An effective PBM should be able to digitally connect with a real-time benefit check vendor to determine if cash pay will be less expensive at the point of sale. As the customer fills the prescription at the pharmacy, real-time checks determine if there is a cash pay deal that is cheaper than the contracted insurance rate. If there is, the customer is automatically charged the less expensive cash pay price.

PBMs should then coordinate with their real-time benefit check vendor to ensure any money the consumer spent is appropriately applied to the member’s accumulators. This option may have the best benefit to the consumer, since the patient receives the advantage of the lower cash pay cost, while still having the cash out of pocket apply to their deductibles and out-of-pocket maximums. Additionally, health plan sponsors save since the final cost of the drug is lower than what they would have paid.

Lower-cost Pharmacies

Finally, PBMs should seek connections with industry-disruptive, lower-cost pharmacies, such as Cost Plus Drugs. Such services provide a simple, seamless, and transparent process to ensure people can access the prescriptions they need to stay healthy. Cost Plus Drugs, for example, encompasses medications for many common conditions, including high blood pressure, certain cancers, dementia, asthma, diabetes, and more.

Scripius uses simple links inside our digital member experience that lead to landing pages where members can view their options through potentially lower-cost home delivery pharmacies, including Cost Plus Drugs.

Additionally, the Scripius and Cost Plus Drug collaboration allows members to use their insurance benefits at this online pharmacy, giving members who don’t want to cash pay, but want to use their insurance benefits, potential cost savings.

It takes multiple tactics

Deploying all three of the above strategies can help ensure plan sponsors and their members pay the lowest net cost for prescription medications. For more market analysis and case studies about effective PBM management, visit or follow us on LinkedIn.

[1] Prescryptive 2022 Research Report - Rewriting the Script: Independent Pharmacy Trends

[2] IQVIA LAAD Pharmacy Claims data, IQVIA Market Access Strategy Consulting Analysis