Prescription Features

The day of the $5 copay for medicine is long gone or will be shortly. Health insurance companies are combating higher and higher prescription costs and are now passing on a portion of those cost to the insured.

Prescription features come in a variety of options. Simple copays are your most common option. You have the choice of lower copay for generic and higher copay for brand name drugs. However there are several drawbacks to this plan. First if a doctor prescribes a drug that is not on what they call a formulary (a list of approved prescriptions) you pay 100%. Second this type of prescription plan is very expensive for health insurance companies and nobody wants to pay full price when they have a prescription card. The new answer to this issue is to charge even a higher copay for non-formulary drugs or 50% which ever is greater. To complicate things even further, health insurance companies are now attaching a separate calendar year deductible that you have to satisfy before you can utilize your copays and or co-insurance.

However there is a more simple approach that works best for both the insured and the insurer. No matter what happens to the cost of the prescription both parties share a portion of the prescription cost with no formulary. You first satisfy a small calendar year deductible then you pay 10% or 20% and the health insurance company pays 90% or 80%. This is a fair and simple approach that encourages the insured to purchase the generic drug and the health insurance company now has a limit on the portion they pay. If you need any more explanations on prescription features you can call 1-888-627-0968.