How GoodRx works with Medicare prescription benefits

You can use GoodRx with Medicare, but the way it works depends on which part of Medicare you have and whether you are in the coverage gap. GoodRx is a discount program that negotiates lower prices directly with pharmacies — it is not insurance. When you use GoodRx, you are paying out of pocket at a reduced rate rather than using your Medicare drug coverage.

The key decision is whether the GoodRx price or your Medicare copay will cost you less at the pharmacy counter. Some people find GoodRx cheaper for certain medications, especially during the coverage gap (the period after you have spent $5,050 out of pocket in 2024, when Medicare coverage temporarily stops). Others find their Medicare plan costs less. You have to compare the two prices before you fill the prescription.

Medicare does not prevent you from using GoodRx, but you cannot use both at the same time. When you hand the pharmacist a GoodRx coupon, you are choosing the discount price instead of running it through your Medicare plan. The pharmacy will not submit the claim to Medicare.

Key Takeaways

  • GoodRx is a discount program, not insurance, so you pay out of pocket at a reduced pharmacy price rather than using your Medicare drug plan.
  • You choose GoodRx or Medicare at the pharmacy counter — you cannot use both for the same prescription fill.
  • GoodRx can sometimes be cheaper than your Medicare copay, especially for brand-name drugs or during the coverage gap.
  • The GoodRx price varies by pharmacy and by dosage, so you should compare prices across multiple pharmacies before filling.
  • Using GoodRx does not count toward your Medicare deductible or out-of-pocket maximum, which may matter if you are close to reaching them.

When GoodRx might save you money

GoodRx often has lower prices than Medicare copays for brand-name medications that have no generic version, or for generics where your plan's copay is high. You can search any medication on the GoodRx website or app and see the price at pharmacies near you. The same drug can cost different amounts at different chains — CVS, Walgreens, Walmart, and independent pharmacies sometimes have very different GoodRx prices for the same prescription.

The coverage gap is a common time when GoodRx becomes attractive. Once you have spent $5,050 out of pocket in 2024 (the amount changes each year), Medicare stops covering your drugs until you reach your out-of-pocket maximum. During this gap, you pay the full pharmacy price. GoodRx discounts can cut that full price significantly, making it worth using instead of waiting for coverage to resume.

Generic medications are another place where the math sometimes favors GoodRx. Many pharmacies offer generic antibiotics, blood pressure medications, and diabetes drugs for $4 to $10 with GoodRx, which may be less than your Medicare copay depending on your plan tier.

When Medicare coverage costs less

Your Medicare Part D copay is often cheaper than GoodRx, especially if you are in a lower tier of your plan. Tier 1 and Tier 2 drugs (usually generics and common brand-name medications) often have copays of $5 to $15, which beats most GoodRx prices. If your plan has a low deductible or you have already met it, using Medicare means the cost counts toward your out-of-pocket maximum and brings you closer to catastrophic coverage.

Catastrophic coverage kicks in once you have spent enough out of pocket — in 2024, that threshold is $7,050. After that point, Medicare covers 95 percent of your drug costs for the rest of the year. If you use GoodRx instead of Medicare, those GoodRx payments do not count toward this threshold, so you stay out of pocket longer.

If you take multiple medications regularly, the cumulative effect matters. Using Medicare for all your prescriptions builds toward your out-of-pocket maximum faster, which means you reach the point where Medicare covers almost everything. Using GoodRx for some drugs and Medicare for others can leave you paying more overall.

How to compare GoodRx and Medicare prices

Before you fill any prescription, search the medication on GoodRx and note the lowest price you see. Then call your pharmacy and ask what your Medicare copay would be for the same prescription. Compare the two numbers and choose the lower one. This takes five minutes and can save you money on every fill.

When you search GoodRx, you will see prices from multiple pharmacies in your area. Prices vary by location and by pharmacy chain, so do not assume the first result is the best. You can also filter by pharmacy if you have a preferred location. GoodRx shows you the coupon code or digital coupon you will need at checkout.

Keep in mind that GoodRx prices can change, and so can your Medicare copay if you switch plans during open enrollment. What was cheaper last month might not be this month. If you take the same medication regularly, it is worth checking both prices every few months.

What happens when you use GoodRx at the pharmacy

Tell the pharmacist you want to use GoodRx before they process the prescription through Medicare. You can show them the GoodRx coupon code on your phone, or you can give them the GoodRx card if you have one. The pharmacist will ring up the prescription at the GoodRx price instead of submitting it to your insurance.

The pharmacist may ask why you are not using Medicare. This is normal — they are checking that you understand you are paying out of pocket. You can straightforward say you compared the prices and GoodRx is cheaper for this medication. There is no penalty for choosing the discount price.

Once you pay, that transaction is complete. It does not go to Medicare, so it does not count toward your deductible, your out-of-pocket maximum, or your progress toward catastrophic coverage. If this matters for your situation — for example, if you are close to reaching your out-of-pocket maximum — factor that into your decision.

GoodRx and Medicare Part D plans

All Medicare Part D plans allow you to use GoodRx. Some plans are more generous than others, which means some people will find Medicare cheaper more often. Plans with low copays for generics and brand-name drugs make GoodRx less attractive. Plans with high copays or high deductibles make GoodRx more competitive.

If you are shopping for a Part D plan during open enrollment, you can use the Medicare Plan Finder tool on Medicare.gov to see what your copays would be for the medications you take. Then compare those copays to GoodRx prices for the same drugs. This comparison can help you decide which plan to choose.

Some people find that their plan is expensive for certain medications but cheap for others. In that case, you might use Medicare for the cheap ones and GoodRx for the expensive ones. This strategy works as long as you keep track of which prescription you are using which method for, so you do not accidentally double-pay.

Things to know before you use GoodRx

GoodRx does not work with Medicare Extra Help (also called the Low-Income Subsidy). If you receive Extra Help, you should use your Medicare plan instead, because Extra Help covers most of your drug costs and GoodRx will not save you money. Using GoodRx when you have Extra Help means you lose the subsidy benefit.

GoodRx prices are for cash pay only — they do not explore if you are using any insurance. This means you cannot use a GoodRx coupon and then also submit the claim to Medicare. You have to choose one or the other at the pharmacy counter.

Some medications are not available on GoodRx, or the GoodRx price is not significantly lower than your Medicare copay. For those drugs, Medicare is usually your better choice. GoodRx works best for expensive brand-name drugs, specialty medications, and situations where your Medicare copay is very high.

Frequently Asked Questions

Can I use GoodRx if I am in the donut hole?

Yes. The coverage gap (donut hole) is actually one of the best times to use GoodRx, because Medicare is not covering your drugs at all during that period. You are paying the full pharmacy price, and GoodRx can reduce it significantly. Once you reach your out-of-pocket maximum, Medicare coverage resumes and you may not need GoodRx anymore.

Does using GoodRx hurt my Medicare plan?

No. Using GoodRx does not affect your plan or your coverage. However, GoodRx payments do not count toward your deductible or out-of-pocket maximum, so if you are close to reaching those thresholds, using Medicare might get you to catastrophic coverage faster.

What if my pharmacy does not accept GoodRx?

Most major chains and independent pharmacies accept GoodRx, but a small number do not. Call your pharmacy ahead of time to confirm they take GoodRx coupons. If they do not, you can transfer your prescription to a pharmacy that does, or use your Medicare coverage instead.

Can I use GoodRx for mail-order prescriptions?

Some mail-order pharmacies accept GoodRx, but not all. Check the GoodRx website to see if your mail-order pharmacy is listed. If it is not, you can use your Medicare plan or transfer the prescription to a retail pharmacy that accepts GoodRx.

Will my doctor know if I use GoodRx instead of Medicare?

No. Your doctor does not receive information about which payment method you used at the pharmacy. Using GoodRx is a private transaction between you and the pharmacy. Your doctor will not know unless you tell them.