Insurance and NiceRx

In some cases, insurance doesn’t provide the best deal. This could be due to high copays, high deductibles, or maybe because your prescription drug isn’t covered by your health insurance company’s formulary. You might also be in the ‘donut hole’, the coverage gap that temporarily limits your prescription drug coverage until you have met the minimum out-of-pocket expenses required by your drug plan.

In many cases, getting your medication through NiceRx can actually save you money compared to the high copays or coinsurance charges that are incurred when buying your medication through insurance.  Fortunately, you can get your medications through NiceRx instead of your insurance.  Here is a detailed guide that explains how to determine which option is better for you.

Can I use NiceRx instead of using my insurance?

You can use NiceRx if the price of your medication through your health insurance or Medicare is more than $49 per month. You cannot use NiceRx and insurance at the same time. You can, however, use NiceRx as an alternative to your prescription drug insurance or government-funded programs, including Medicare and Medicaid for accessing your prescription drugs. NiceRx is not insurance or a drug discount card.

To find out if you are eligible for assistance through NiceRx, get started and complete your online enrollment. NiceRx will notify you if you are eligible to receive your medication for $49 per month, with our help.

Our advocates are available to help you if you have any difficulty enrolling online on your own. Contact us if you have any questions.

10 drugs that could be cheaper with NiceRx than your insurance

Drug nameEstimated retail priceEstimated insurance priceNiceRx priceEstimated monthly savings
Trelegy Ellipta$620$155$49$106

Note: Estimated insurance prices are calculated based on the manufacturer’s list price or average list retail price, and the maximum copay of 25% of the price of the drug once you reach your coverage gap. Your insurance price may vary depending on the copay or coinsurance set by your insurance company.

How to decide between my insurance and NiceRx?

You can compare prices at home and don’t need to wait until you get to the pharmacy to find out if getting your medication through NiceRx will be cheaper for you. Here’s how:

1. Check the insurance price for your medication

Login to your health insurance company’s online portal and find the “Price a Medication” link that is typically located in your Pharmacy Benefits section. Review any possible restrictions, including prior authorization, quantity limits, or step therapy. Also check if you have a deductible, which requires that you pay the full list price for the medication until you reach the coverage gap (out-of-pocket) limit.

2. Compare your insurance price with NiceRx

NiceRx charges a flat monthly fee of $49 for each eligible medication. If you are eligible for assistance, NiceRx will help you access your medication directly from U.S. pharmaceutical companies.  If your insurance price is higher than $49 per month and you are eligible for assistance, NiceRx may be a better option to help you save money!

3. Choose the best option for you

Depending on what the copay fee or coinsurance percentage charge will be through your insurance company, NiceRx might be the better option for you to save more money.

Why is NiceRx cheaper than my insurance company?

While your health insurance company may help cover your major medical expenses, the cost of healthcare is continually increasing at a rate higher than inflation, and many insurance plans are covering less than they used to.

Insurance companies will use a drug formulary, which is an approved list of drugs that they will cover at tiered prices. If your prescription drug is placed on a higher tier on the insurance company’s formulary, or if it is considered as a non-preferred drug in the formulary, that may result in a higher copay or no coverage.

As well, if your insurance plan has a deductible for prescription drugs, you may be required to pay the full list price for your prescription drug until you reach the coverage gap (out-of-pocket maximum).

If the insurance price for your medication will cost you more than $49 per month, NiceRx may be a better option for you to save money instead of paying for your medication with insurance.

Can I get reimbursed by my insurance company if I use NiceRx?

NiceRx is completely separate from your insurance. When using NiceRx’s service, you are choosing to pay for your medication without insurance. Typically, insurance companies do not reimburse for NiceRx’s service and it’s up to the insurance company to decide if they will reimburse you.

Medically reviewed

A medical professional has reviewed this article.

Jamie Winn, PharmD
Jamie Winn, PharmD

Jamie Winn, PharmD

Medical Writer & Reviewer

Jamie Winn, PharmD

Medical Writer & Reviewer

Dr. Jamie Winn received his Doctor of Pharmacy in 2002 from the University of South Carolina College of Pharmacy, Columbia, SC. Jamie is a medical reviewer for NiceRx.