GoodRx vs. Your Health Insurance
One of the most significant points of confusion for consumers is the interaction between GoodRx and health insurance. Simply put, you cannot use both simultaneously for the same prescription. When you use a GoodRx coupon, you are essentially paying the "cash price" or "out-of-pocket" price for the medication, which is an alternative to using your insurance. This has several key implications for your overall healthcare finances.
Impact on Your Annual Deductible
Perhaps the most important factor to consider is the impact on your annual insurance deductible and out-of-pocket maximum. Prescription purchases made using a GoodRx coupon typically do not count toward these annual spending limits. For individuals with a high-deductible health plan, using GoodRx for cheaper, routine medications might seem like a good idea in the short term. However, if you later face a major medical event that pushes you toward your deductible or out-of-pocket max, the money you saved using GoodRx will not be factored into that total. Ultimately, you may have saved on a few small prescriptions but paid more overall for your care.
Comparing Prices is Essential
GoodRx often markets that its prices can beat an insurance copay, and this is frequently true for many generic drugs. But it's not a universal rule. To ensure you're getting the best deal, you must compare the GoodRx coupon price against your insurance copay every single time you refill a prescription. Prices fluctuate, and what was cheaper with GoodRx last month might be cheaper with your insurance this month, or vice-versa.
The Catch with Data Privacy
For years, one of the biggest catches with GoodRx was its handling of user data. The Federal Trade Commission (FTC) took enforcement action against GoodRx in February 2023 for its "not-so-good privacy practices".
FTC Action and Data Sharing
The FTC alleged that GoodRx had shared sensitive personal health information, including prescription medications and health conditions, with third-party advertising companies like Facebook and Google. This was done contrary to the company's privacy promises and without user consent. According to the FTC, GoodRx used this data to target users with personalized health-related advertisements.
The Settlement and Aftermath
As part of a settlement, GoodRx was required to pay a $1.5 million civil penalty and was permanently prohibited from sharing user health data for advertising purposes. It must now obtain a user's explicit, affirmative consent before sharing health information for any non-advertising purpose. The company must also implement a data retention schedule and publicly post it. This settlement, along with a separate class-action settlement, shows that the company's past data practices were a serious issue for consumers. While GoodRx has since updated its policies and received a HITRUST i1 Certification for data security in February 2025, users should remain aware of the company's history with data privacy. You can learn more about the FTC's initial action on their official website.
Pricing Volatility and Pharmacy Inconsistency
GoodRx isn't a silver bullet for consistently low prices. The discounts available are subject to frequent changes, and not all pharmacies participate in the same way.
Prices that Fluctuates Frequently
GoodRx prices are not static; they can change daily, weekly, or monthly. This makes long-term budgeting for maintenance medications challenging. The price you saw online or in the app last month may be significantly different when you go to refill your prescription, requiring you to re-check and possibly change pharmacies to get the lowest current price. This process can be a hassle and might require driving to a different location, erasing any savings you might have found.
Issues with Pharmacy Acceptance
GoodRx works by partnering with Pharmacy Benefit Managers (PBMs) to offer their negotiated discount rates. However, participation is not uniform across all pharmacies. Independent, smaller pharmacies, in particular, may find the reimbursement rates from GoodRx's PBMs to be so low that they lose money on the transaction. As a result, some independent pharmacies may not accept the coupons. Even within large chains, different locations can have different pricing due to variations in their PBM contracts, adding to the pricing unpredictability.
The Underlying Business Model
To understand the catches, it's helpful to understand the underlying business model. GoodRx is not a charity; it is a for-profit technology company that makes its revenue through several streams.
- Pharmacy Transaction Fees: GoodRx receives a portion of the fee that pharmacies pay to PBMs for processing a discount coupon.
- Telehealth Services: The company offers telehealth services and takes a cut from the fees.
- Subscription Fees: The premium GoodRx Gold subscription provides deeper discounts for a monthly fee.
- Advertising: GoodRx sells advertising space on its platform to drug manufacturers and other healthcare providers.
This model depends on a complex and often inflated pharmacy pricing system in the U.S. that GoodRx itself helps exploit. Without high initial cash prices at pharmacies, GoodRx's discounts would be far less dramatic.
Compare Before You Pay
To make the most of prescription savings and avoid the catches, always compare your options. Here’s a quick overview of what to consider:
| Feature | GoodRx | Health Insurance |
|---|---|---|
| Compatibility | Cannot be combined with insurance | Must be used alone |
| Deductible Contribution | Does not count toward your deductible | Often counts toward your deductible and out-of-pocket max |
| Price Fluctuation | Prices can change daily or weekly | Copays are generally stable, but prices vary by plan and formulary |
| Best for | Lower-cost generics, uninsured individuals, or non-covered drugs | Higher-cost or brand-name drugs, especially when meeting a deductible is a priority |
| Data Sharing | Past FTC violations; now must obtain consent for non-ad sharing | Governed by HIPAA, with strong privacy protections |
When to Use GoodRx vs. Insurance
To navigate the trade-offs, consider these strategies:
- When to Use GoodRx: Use it for low-cost generic medications, especially if you have a high deductible and know you won't reach it this year. It's also ideal if you are uninsured or your insurance plan does not cover a specific medication.
- When to Use Your Insurance: Prioritize using your insurance for expensive or brand-name medications. This ensures your spending contributes toward your deductible and out-of-pocket maximum. Also, if your insurance copay is lower than the GoodRx price, stick with your insurance.
Conclusion
For many, GoodRx provides valuable and accessible savings on prescription medications, but it is not a perfect solution. The biggest catches lie in the trade-offs: you exchange your insurance benefits and deductible progress for a potentially lower cash price and must navigate a system of fluctuating prices and varying pharmacy participation. Moreover, past serious issues with data privacy serve as a cautionary tale, although GoodRx has since been ordered to change its practices. The smartest approach is to use GoodRx as a comparison tool, not as a replacement for your health insurance. By comparing both your insurance copay and the latest GoodRx coupon price before each refill, you can make an informed decision that best suits your financial and health needs.
