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Here we're going to discuss
prescription coverage (RX) on the
individual and family plan market. Groups
will be much the same, but not quite.
As you may have noticed, the
cost of your brand name drugs has been going up
even faster than the cost of your health
insurance. In fact, the last rate increase
letter from your health carrier sited rising
cost of RX as one of the leading factors in
their premium increase. And despite all
the noise from Washington, this trend will
probably continue.
Remember when your Doctor gave
you enough samples to go a month or two?
The Pharmaceutical companies don't seem to
market that way much anymore. Instead, you
get the barrage of RX commercials during the
evening news. The thought behind that is
that the Doctors weren't pushing their drugs
enough, so they have us going in to ask for the
drugs from the Doctors. Pretty smart, huh?
Those commercials during the news hour cost a
lot and we're paying for them through our
insurance premiums and at the pharmacy.
Consequently, to keep the cost
of your insurance plan from going completely
beyond your mortgage, your plan will now come
with a separate deductible for brand name and
non-formulary prescriptions. And many
plans will not even cover the brand and
non-formulary drugs.
The question we get most
frequently is; what's the difference between
Formulary vs. non-formulary. Formulary simply
means that the company recognizes the drug as
being effective and therefore covered. It
also means the drug is still too expensive for
them to cover it as a brand name drug and they
wish to pass more of the cost sharing to the
subscriber.
Got a question? Give us
a call and we'll do our best to answer your
specific Questions.
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