In your Check Your Health Coverage column last week, you talked about employer plans switching from co-payments to co-insurance, which can increase the out-of-pocket costs for people with expensive drugs. How does this work, and what are some good tools to help find lower-priced alternatives?
The new rules make it even more valuable to find low-priced drugs. In the past, many health insurance plans charged fixed co-payments of $10 or so whenever you filled a prescription -- no matter how much the drug actually cost.
But now they're charging co-insurance, which is based on a percentage of the drug's cost. The higher the price, the more you'll pay.
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And insurance plans are adding an extra incentive to find generic alternative. Not only are they charging you a percentage of the drug's cost, but also they're charging different co-insurance rates based on the level of drug.
For example, they're charging 10% of a generic drug's cost, 20% for a brand-name drug on the plan's approved list, and 30% for a brand-name drug not on the formulary, says Dave Guilmette, managing director of health and welfare consulting for Towers Perrin. So if you find a generic alternative, for example, you'll pay a lower percentage of a lower-priced drug's cost.
If you're taking a high-priced brand-name drug, ask your doctor if you may substitute a drug on the formulary or a generic for your current prescription.
Go to Rxaminer.com to search for generic alternatives or, if there isn't a generic, for lower-priced drugs with a similar effect. Rxaminer creates a prescription drug pricing report, listing the retail and mail-order cost of that drug as well as generic and other alternatives. Plus, it provides other strategies for cutting your costs (such as pill splitting).
Before you take any action, present the report to your doctor to find out whether it's safe for you to make the change. The company also provides customized versions of the site to several large employers, insurance companies and prescription benefits managers, with details about the coverage and co-insurance costs for each drug under that specific health insurance policy.
Another great resource is CRBestBuyDrugs.org, which includes detailed drug reports discussing how the drug works, as well as information about price and effectiveness and recommendations for low-cost generics.
Your health insurance company may also have Web-based tools to help you compare drug costs within your plan -- based on the specific co-insurance rates -- and may even list prices at several local and mail-order pharmacies.