2017 Coverage Changes
2017 has arrived. As far as your health insurance is concerned, January means a new insurance company for many people, new benefit plans, changes in networks, deductibles start over (ugh), and new guidelines for prescription drugs.
It’s a good idea to check your benefits before the first trip to the doctor or pharmacy to minimize any surprises. There are big changes in pharmacy benefits for 2017. Many plans offer copays for generic drugs only; meaning that you will pay either the full price or a percentage of the price (after network discounts) for your name brand medications. Some pharmacies are NOT in-network, depending on what insurance company you have.
- In an effort to control pharmacy expenses BCBS is making a big change to their pharmacy network and prescription benefits. BCBS will have two tiers of pharmacies – Preferred and In-Network. Better benefits are available if you visit a Preferred pharmacy. You can search the new pharmacy network at https://www.nebraskablue.com/resources/pharmacy-tools/find-a-pharmacy CVS and Target will be Out of Network.
- If you are on a plan with prescription copays, you will be paying a percentage of the drug cost for name brand and specialty drugs. Generics will still have a copay. The copays and percentage amounts will differ based upon if you use a Preferred or In Network pharmacy. Be sure to review your 2017 benefit summary to understand the new benefits.
- If you have an individual policy with Aetna in 2017, Walgreen’s will not be in the network. There are also several independent pharmacies that are not in the Aetna network.
A formulary is a list of prescription drugs and a description of how each drug is covered by an insurance company. Each medication is typically classified as Preferred Generic, Generic, Preferred Name Brand, Non-Preferred Name Brand, and Specialty. Drugs that are not included on the formulary or that appear as Not Listed will not be covered by your insurance benefits. Formularies change annually and sometimes quarterly. You will typically pay a much higher cost if a generic version of your medication is available, but you choose to use the name brand version. Check the formulary of your insurance company to find out how your medications are covered. Do not assume that coverage will be the same in 2017 as 2016. If your medication is not covered, it may be possible to work with your doctor to obtain an exception.