Prescription Plans

Americans, the heaviest users of prescription drugs in the world, sometimes have the benefit of prescription plans that help the consumer lower costs. The plans are usually part of the benefits from your insurance group, your HMO, PPO, POS, or other group system.

How do prescription plans work?

How they work is this: the large organization, to which you belong through your group health coverage, contracts with a vendor of prescription drugs. This vendor works with a large number of pharmacies across the United States. Because this group of pharmacies generates a large volume, they can discount the prescription drugs.

For the sake of example, let’s discuss how a prescription plan with a PPO works. The PPO provides its member with a medical I.D. card and a listing of drugs that will be divided into several groupings. When the doctor writes a prescription for a drug, the patient takes it to a member pharmacy where the I.D. is recognized. The pharmacist fills your prescription with a generic form of the drug, if it is available. If a generic is not made for that drug, it will be filled by the actual drug (called preferred brand). The generic drug may cost $15 while the preferred drug would be more, maybe $35. There may also be a mail-order prescription program, whereby your maintenance type drugs are mailed to you in 90 day supplies.

Are there any disadvantages?

The insureds will be encouraged to ask doctors for preferred drugs, rather than what are called non-preferred drugs. Some of these require pre-authorization for use and may have a number limitation (refill reduction) each time it is filled. The insurance company may even suggest the use of a drug on the preferred list instead and may have limitations on many drugs which the company does not cover in its plan. It is up to you, as the consumer, to be knowledgeable about those drugs that are covered.

Prescription plans keep the costs of prescribed drugs much lower for people who have the advantage of using one.