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  How plans handle what is increasingly the most costly part of visiting the 
  doctor...prescriptions

 
Brand name prescriptions have been increasing 20% per 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 Fomulary 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...Unicare 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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