Drug Coupons Explained
We encourage and help anyone we can to obtain a coupon for their prescriptions.. We know, however, that there are emerging issues with them.
Drug manufacturers have some amazing but expensive medications. They have created coupon programs that help the consumer pay for the prescriptions up until that consumer reaches their insurance company deductible (most coupon programs require the consumer has insurance).
For the consumer, that appears to be fine. That is the good.
Once the member meets their deductible (even though they may not have actually paid that full amount, due to the coupon), the insurance company is hit with the cost. For the remainder of the year the carrier is paying the full cost on refills for that prescription. That is the bad (at least for the insurance company).
The battle between the manufacturer and insurance company is now heating up. The manufacturer wants to let the consumer off the hook for the cost (so they will use their product) but wants to get to the carrier reimbursement portion. Some insurance carriers have concluded that since the consumer did not actually pay for the prescription, deductible credit should only be given for what the consumer actually paid. We assume more carriers will follow suit.
We are beginning to see the consumer caught in the middle. The manufacturers do not want to keep filling the prescriptions for free. If they see that the member was not given deductible credit from the insurance carrier, the member is then billed for the full cost. The consumer assumes the coupon will work and does not find out it was rejected until after the prescription has been filled. The consumer then gets billed. And, that is the ugly.
We at BBG still see the coupon option to be worth researching and using. However, we are urging our clients’ employees and dependents to research this and reach out to us for help. We know a lot about these options and are learning how get ahead of being blindsided.
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- Mike Barrett
- September 28, 2018
- confusion, cost, costs, coverage, drugs, employees, health plans, healthcare, high deductible, insurance, prescription, trends
- 0 Comments
On June 19th the Department of Labor released final regs that offer new options for associations to sponsor health plans for their members. There’s no clear picture yet of what will emerge out of the new “Association Health Plan” (AHP) regs and how the new regs will impact health coverage options for small businesses. Here are a few of the highlights from what we know so far about the status and the market implications of the new AHP regs:
- Association plans will be treated as large employer plans. This frees them from some of the ACA provisions (i.e. Essential Health Benefits or EHB’s) that apply to small group and individual plans. AHP’s are still required to comply with the ACA and ERISA rules that apply to large employer plans (e.g. ACA – deductible/out of pocket, preventive care, annual and lifetime limits, minimum actuarial value, etc; ERISA – Cobra). And, fully insured plans must also comply with state mandated rules that apply.
- A major piece of the new AHP regs is that Individual states are maintaining their existing authority (as established under ERISA) and will continue to regulate AHPs as they currently do. This is expected to make multiple state AHP’s difficult to establish. AHPs will have to comply with the rules in the state where the employee is located regardless of where the policy originates.
- In general, states are being very deliberate in reviewing the new regs and appear to be slow-walking how they will respond to and assimilate these recent changes. Adding to the crawl is the fact that twelve (12) states have responded by filing suit and legally challenging the law.
- Also, from what we hear, there hasn’t been much reaction, interest or enthusiasm to jump in on the part of the established insurance carriers.
We’ll continue to monitor and report back with any significant developments. For those interested in peeling back the onion on the new regs, healthcare attorney Larry Grudzien has an informative webinar posted on his website that does a good job of diving into the details.