Amazon and GoodRx are promoting cash-pay prescription plans to insured employees. These purchases normally sit outdoors the group plan, which issues for deductibles, claims knowledge and 2027 renewals
A $5 month-to-month price is now shopping for some American employees the predictable prescription prices their well being plan was meant to supply.
Amazon’s RxPass launched in January 2023 as a $5-a-month add-on for Prime members. It covers generally prescribed generics for greater than 80 circumstances and contains free supply. Amazon has since opened it to Prime members on Medicare and expanded it to 48 states.
GoodRx launched its $14.99-a-month Companion plan in Might. It contains greater than 200 widespread generics at no cost, tons of extra for underneath $10, $19 telehealth visits, and reductions on dental, imaginative and prescient, lab and imaging companies. The corporate is advertising and marketing it to folks whose out-of-pocket prices hold rising despite the fact that they’ve insurance coverage. Mark Cuban’s Value Plus Medicine and a number of other smaller firms are competing for a similar prospects.
The businesses describe their merchandise as add-ons to insurance coverage. In apply they compete with the pharmacy profit on value, and they’re rising as employer plans head into an costly renewal season.
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Marsh tasks whole well being profit price per worker will rise a median 8.2% in 2027, the steepest enhance since 2003, and 11% if employers make no plan adjustments. Aon places the rise at 9.5%, taking common price per worker above $19,000 earlier than plan adjustments. WTW‘s preliminary determine for employers that take no motion is 11.1%.
Staff are already paying extra. Aon estimates their out-of-pocket prices averaged about $2,167 in 2026, 10% greater than in 2025. That’s the price the subscription firms promote towards.
Drug spending is rising quickest. Segal’s annual survey of insurers, PBMs and TPAs tasks prescription prices will climb 11.5% in 2027.
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The person market is underneath extra pressure. 2026 is the primary yr since 2020 with out enhanced federal premium tax credit, and each state besides New Mexico recorded decrease ACA Market enrollment, in response to KFF. CMS figures confirmed practically 3 million fewer market enrollees in February 2026 than a yr earlier. A few of these folks will be a part of employer plans as new hires, spouses or dependents, and a few will already be used to purchasing medicine for money.
Progress after a flat yr
GoodRx’s subscription enterprise had been shrinking. Subscription income fell 3% in 2025, to $83.8 million, because the variety of plans declined. It reversed in 2026. In line with the corporate’s second-quarter submitting, subscription income rose 39% to $28.5 million, primarily from condition-specific applications, weight reduction particularly. Subscription plans grew 14%.
The burden-loss development is the half brokers ought to watch. It comes as extra employers drop GLP-1 weight problems protection and a few staff search for different methods to pay.
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Amazon would not publish RxPass enrollment. Amazon Pharmacy vice chairman John Love advised Reuters this week that the shopper base has practically tripled since launch and that greater than 70% of customers fill three or extra drugs by means of this system. He additionally stated many customers have insurance coverage however select to pay money.
The drug lists are nonetheless quick. RxPass covers about 50 generics. Value Plus Medicine has no subscription price; it costs every drug at its acquisition price plus a 15% markup, plus pharmacy labor and delivery charges.
What it means for the group plan
For a lot of particular person staff these plans lower your expenses. The priority for brokers and plan sponsors is what occurs to the profit when prescriptions are stuffed outdoors it.
Deductibles are essentially the most speedy difficulty. When the federal TrumpRx cash-pay website was introduced, Marsh McLennan Company famous that such purchases get no monitoring or credit score towards a member’s deductible or out-of-pocket most. Subscription fills usually work the identical means. An worker on a high-deductible plan can save on generics early within the yr and nonetheless owe the complete deductible when a big medical declare arrives later.
There are exceptions. Value Plus Medicine says it really works with choose teams so claims might be submitted to the member’s insurance coverage, which can rely towards the deductible or out-of-pocket most. Brokers ought to ask whether or not a shopper’s PBM or service has an analogous association.
Claims knowledge is the second difficulty. Prescriptions stuffed outdoors the plan don’t attain the PBM or the employer’s analytics. Adherence applications, illness administration and stop-loss underwriting all rely upon that knowledge. An worker filling metformin by means of a subscription can look, within the claims file, like somebody who stopped taking it.
Worker conduct additionally tells brokers one thing concerning the plan. Aon has cautioned that sufferers might purchase GLP-1s immediately when their plan excludes them or when cost-sharing exceeds the money value. If a shopper’s staff are doing this, the pharmacy profit might be priced or designed in a means they do not worth.
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Employers are testing alternate options
GoodRx is already promoting to employers. In February it launched Employer Direct, which lets employers subsidize producers’ discounted money costs for high-cost model medicine, together with GLP-1s.
The product is constructed to take a seat alongside the present well being plan. As an administrator for Eli Lilly’s employer program, GoodRx additionally affords self-insured employers Zepbound KwikPen at a set $449 throughout all doses, which employers can subsidize additional.
Different employers are wanting outdoors the usual provide chain too. In line with Enterprise Group on Well being knowledge, 17% plan to purchase GLP-1s by means of direct-to-employer preparations that bypass the PBM.
Federal guidelines are altering as properly. The Consolidated Appropriations Act, 2026, would require PBMs to cross 100% of rebates and associated funds by means of to ERISA group well being plans. Most provisions apply to plan years beginning on or after January 1, 2029. KFF’s abstract of the federal PBM reforms is a helpful start line for shoppers.
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Brokers making ready for renewal conferences can put a number of inquiries to carriers and PBMs:
- How do the plan’s generic copays evaluate with a $5 or $15 month-to-month subscription?
- Can verified money purchases rely towards the deductible, and what would that take to manage?
- Can prescriptions stuffed outdoors the plan be captured for scientific applications?
- Have staff on high-deductible plans been advised how money purchases have an effect on their deductible?
Learn subsequent: The PBM conflicts brokers must be speaking to shoppers about
Amazon’s plans transcend generics. Since 2023 it has provided Prime members discounted memberships at its One Medical major care practices. Analysts see RxPass primarily as a solution to deliver prospects into Amazon Pharmacy and hold them in Prime.
Extra staff are actually evaluating money costs with their plan’s cost-sharing, and plans that come out worse on that comparability will lose a few of that spending.
