This is an example of one Ohio company adjusting how they administer coupons people use at the pharmacy. The program helps make sure members’ out-of-pocket cost for prescription drugs are properly applied to deductibles and maximum out-of-pocket amounts.
The benefit of the coupon is easy to grasp. Someone on an expensive brand medication can obtain it at low or no cost.
The problem can be that the carrier processes it as a paid claim and the member never pays what the plan requires. There are reasons both employers and carriers want real out of pocket to be met by the member.
The carriers now are adjusting and working on ensuring that the member is not given credit or given a reimbursement for something they never paid for personally. Members can use the coupons, but the carrier will credit only what the member actually paid.
This seems like a reasonable solution. It will likely become a normal way coupons are processed.