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Prescription Drug Coverage and Group Benefits

Posted March 23rd, 2012 in articles by admin

Prescription drug coverage is by far the most utilized part of most group benefits plans.
This can cover everything from inexpensive antibiotics to cost-prohibitive cancer medications.

When most people first sign onto a plan, this is the coverage they want most, especially if they have a family. For the most part, you can live with the costs of the most common medications, bit it can quickly become cost-prohibitive when a serious illness hits. Like all insurance, this coverage is in place just in case something happens that would otherwise harm you financially.

It’s also nice to have in place because it is often at least partially paid for by an employer. In this case, it becomes a great benefit because everything from the smallest to the largest prescription becomes far less significant a cost to you and your family.

In an effort to control costs, many prescription drug plans have a cap or limit to how much can be used.
These caps are often in the millions for a lifetime, so most of us will never hit it. However, it is a consideration when looking at the quality of a plan.

Another cost controlling feature is limiting which drugs are covered by the prescription drug coverage.
Depending on the plan, treatments deemed unnecessary such as botox or even fertility drugs are not covered. Some plans do cover these things, so it’s important to know what you are covered for before you commit yourself to an elective treatment.

The most common cost controlling feature is only covering generic brand drugs as opposed to paying for the name brand. These drugs are most often identical to the brand name, but they are much less expensive. Many pharmacies will give you the generic brand automatically whether you have a plan or not. In some cases, when the generic drug is not identical to the brand name version, your doctor may be able to specify that the brand name must be used if the differences in the generic brand cause an issue or is less effective for the patient. When the doctor issues such a note with the prescription, many, but not all prescription drug plans will cover it.

As with any insurance, it’s of the highest importance to understand what you are covered for. If you can’t figure it out with the documentation provided to you by the insurance company, call them and ask them the question directly. Make sure you note the date of the call, the question asked and the person you spoke to. Even better, if you can ask via e-mail, you have a written record of the question and answer.

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