This chart illustrates the increase in Prescription Drug Spending and Total US Private Health Insurance from 1990 through 2013 (stated in $ billions)
Prescription drug benefits provided by health insurance policies, particularly for small employer groups and individuals, continue to evolve as insurance companies strive to manage costs.
• Typically, benefits for generic drugs provide much lower costs to the policyholder.
• In comparison, the use of name-brand drugs frequently requires the payment of a prescription drug deductible before more attractive co-pay benefits can be accessed.
• The formularies for prescription benefits are becoming more restrictive with more frequent use of Step Therapy requirements. “Step Therapy” means that the patient must try less expensive medications before insurance coverage will be approved for the more expensive option.
• Higher cost drugs that were previously paid by insurance are no longer eligible for coverage or require the policyholder to pay a much higher share of the cost.
As our clients began using their 2015 health insurance benefits, we had many reports of prescription drug issues. As we have researched these instances, it has become clear that patients must become proactive consumers in the purchase of prescription drugs.
• Know the name brand and generic equivalents of the medications that you use
• Know which pharmacies have a “preferred” status with your insurance company
• Contact the insurance company before you fill a new prescription to find out how it will be covered and if there are any limitations
Here is an example of being a wise consumer for prescription drugs. I am the patient in this case. I was prescribed a generic medication that was a combination of two drugs. The price, even for the generic, was $75 per month. When refilling it for the second month, I asked the pharmacist for other options. He suggested taking the two medications included in my prescription as separate drugs. That would mean taking 2 pills per day, instead of 1. When I discussed this option with my doctor, she was surprised at the $75 per month cost and gave me new prescriptions for both medications. Now the monthly cost is a total of $8 per month.
It doesn’t always work out this way, but be diligent in looking for less expensive options for your prescription drugs. Your health care professionals are focused on the health of their patients, NOT the cost of prescription drugs. Your pharmacist is a valuable resource. If you do not know how to access the formulary or how to contact your health insurance plan with questions, contact your health insurance agent for the information.
by Chris McPike, Vice President
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www.comproins.com