Overview
Co-Pay cards are manufacturer-sponsored savings programs for certain brand-name medications that help lower out-of-pocket costs for patients with commercial insurance. When used at the pharmacy, these programs can reduce or offset copays, coinsurance or deductibles associated with an eligible prescription. These savings programs are designed to improve access and support ongoing treatment by making medications more affordable for qualifying patients. Co-pay cards are not applicable to prescriptions billed to government-funded insurance programs such as Medicare or Medicaid, and eligibility is determined by the manufacturer. ScriptSure ERX may include co-pay-related information on eligible prescriptions to help pharmacies recognize available savings programs and apply the information during transaction processing.
What the Co-Pay Information Represents
The co-pay information indicates that a manufacturer coverage or savings program may be available for the prescribed medication. The information is informational and is associated with the medication based on its NDC.
The messaging may include:
What the co-pay or savings applies to
Coverage or savings program indicators
Activation or enrollment instructions, when applicable
Example activation URL - this is what will appear in the pharmacy notes field. Pharmacies will provide this to the patient when that patient picks up the medication. The patient can then go to the website to see coverage savings to submit to their insurance fro reimbursement or future savings:
https://zepbound.lilly.com/coverage-savings
Where the Information Appears in ScriptSure ERX
Pharmacy Notes:
Co-pay messaging and activation links may appear in the Pharmacy Notes field
Information is appended only if there is available space
Notes added to the pharmacy notes field are never overwritten or removed
Coordination of Benefits (COB) Segment
Co-pay and savings information also appear in the Coordination of Benefits (COB) segment of the electronic prescription being sent. If the Co-Pay information cannot appear on the pharmacy notes field, this means the data will still exist in the COB field at the very least.
This allows pharmacies to:
More easily identify applicable savings programs
Utilize the data when applying secondary coverage or manufacturer assistance during transactions
Reduce manual re-entry of co-pay-related information
Interaction With Pharmacy Notes:
Prescribers retain full control of the Pharmacy Notes field - any notes entered by users of ScriptSure will still appear. If the Pharmacy Notes field is full, co-pay messaging will not be added there, but may still appear in the COB segment when supported. If there is room for the Co-Pay information (URL) to be added to the Pharmacy Note field, it will be added.
Transmission on the eRx:
When included, co-pay information is automatically transmitted with the prescription:
Sent as part of standard ERX content
No additional action is required by users.
Transmitted consistently across Pharmacy Notes and COB segments, when applicable
Behavior on Re-Prescribed Medications
When a medication is re-prescribed, ScriptSure ERX applies the current co-pay and savings information again.
Key points:
The latest available co-pay information is used
Prior user entered comments may carry forward, but the CO-Pay information will update, when applicable.
Placement in Pharmacy Notes and/or the COB segment follows the same rules as a new prescription
What ScriptSure ERX Does Not Do
Does not change adjudicated copays or claim pricing
Does not guarantee patient eligibility for savings
Does not overwrite pharmacy-entered notes
Does not force insertion if fields have no available space
Relies on pharmacies to utilize the
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