- Uncategorized (86)
- June 22, 2007: Rx Nopays
- May 6, 2007: STM for College Grad
- January 19, 2007: Agent Compensation
- January 18, 2007: Self Insuring
- January 17, 2007: Over Medicated
- January 10, 2007: How Much Do I Need to Say I Weigh?
- January 7, 2007: Underwriting rejection
- December 13, 2006: Pre-existing Conditions
- December 12, 2006: Questions & Opinions
- December 4, 2006: Half a Plan
Rx Nopays
Q. I currently have a plan with an Rx copay. For quite some time I have taken (name withheld) medication and paid my $40 copay. The last time I used my card the pharmacist told me I had to pay over $80 for my medication. My plan has not changed. Why is this pharmacist over-charging me?
A. You are not being over-charged by your pharmacist. Rather, your plan is doing exactly what it should.
If you read your policy (something everyone should do at least once) you will see a 3 tier copay plan. Tier 1 is for generics (and usually the generic copay is much higher than you would actually pay for the med without your card). Tier 2 is for older, more established brand name drugs. Tier 3 has the highest copay and is used for the newer drugs that are regularly advertised in print and on TV.
Your plan Rx manager has noticed that you are taking a tier 3 med that has a lower priced, tier 2 equivalent. The allowance for meds reverts to a lower tier when an equivalent med becomes available.
The same would happen if there were a generic equivalent to a tier 2 or tier 3 med.
You would then be allowed the copay on the lesser priced med and you pay the difference.
If you were to change to a plan without copays you would most likely realize a significant total savings in premium + out of pocket.
July 18, 2007 at 9:22 am
This is a great blog, I should link to you. I was wondering how three tier medication actually works because the way I saw it confused me. Oh, and the poor woman who had to lose weight to qualify for a lower premium. Poor girl.
July 18, 2007 at 12:19 pm
3 tier Rx copays are quite common and there are a few 4 & 5 tier plans.
A 3 tier plan charges the lowest copay (usually $10 - $15) for generic meds; a higher copay in the $25 - $40 range for “established” brand name meds and the highest copay ($50+) for the newest meds.