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Brand name prescriptions have been increasing each year and despite the political
rhetoric...that's probably not going to change for
a while.
In
case you have been away the last couple of years,
pharmaceutical companies have changed the way they
market their products. It use to be that
they would primarily market through the doctor...a
"push" method. Now, with huge
advertising campaigns, they are advertising
directly to you, the consumer in the thought that
you will then go and request that medication from
your doctor...the "pull" method.
Guess what...there is a cost to all this and you
want to make sure your plan covers it.
Most insurance plans handle prescriptions with a copay,
a fixed amount you pay. Typically, there is
a different copay amount for brand name and
generic stemming from the situation I mentioned
above. Across the board, you usually find a
$10 generic copay and a $25 brand name copay but
make sure to check the policy...it might be
different.
They also talk about formulary vs. non-formulary.
Formulary simply means that the company recognizes
the drug as being effective and therefore covered.
In all our years, we have yet to have a problem
with a person receiving a prescription that was
non-formulary.
A recent change which we feel will probably become
the trend is to put a deductible on brand-name
prescriptions. This basically says,
"Try to use generic if you can."
Why?? Well if a month's supply of Prylosec
is $150 and a person is paying $65 month for
comprehensive coverage...you can see the problem.
Either rates will shoot up (as with the last 3
years) or something has to absorb these costs.
That is where the deductible comes in.
Example...most
carriers
instituted varying deductibles based on the plan
for brand name prescriptions for their PPO
plans. The other carriers will
either have to initiate a similar deductible or
continue to raise monthly premiums. This specific brand name
deductible will be the standard.
Well we have made it through...hopefully with
few scars and a great deal more understanding of
how to read the plans.
Again, there may be specific questions you
have which we would be happy to help you with here.
For a final exam, go here
to review plans, rates, and providers for Texas
Health Insurance. There
will be a test afterward...you pass by choosing
the right plan at the right price for you!!
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