The Facts About Generics
Posted on January 3, 2011
And Your Prescription Drug Card Benefit Program
Local pharmacies are promoting $4 generic prescriptions, medications for as little as $1 a week, and some offer selected generic medications for as little as $10 for a 90-day supply. Each pharmacy offers different drugs in these programs – most have nearly 400 generic medications on their list. The hype is appealing – but the truth is that your NPS Network SmartCard™ program always assures plan members these prices – the lowest prices on all their prescriptions – at every fill. Here are answers to some commonly asked questions:
Q: Will I have to pay the higher amount if the co-payment for a generic medication under my plan is greater than the $4?
A: No. You will pay the lowest price – your pharmacy’s cash price or your co-payment, whichever is less. On EVERY prescription claim, the NPS claims processing system checks the pricing to make sure that the lowest price available is the price accepted on the claim. Occasionally, the price that the pharmacy provider submits will be lower than NPS’s contracted network pricing, which is based on the average wholesale price or the maximum allowable cost for brand and generic medications, respectively. In this situation, NPS accepts the price the pharmacy submits, often referred to as the pharmacy’s preferred pricing or the usual and customary price. Members can be assured that they are receiving the lowest possible pricing through state-of-the-art price checking and price analysis that is incorporated into their NPS Network SmartCard™.
Q: What if the medication I am taking is not available on the $4 generic program?
A: Consult with your doctor or pharmacist to see if any of the generic medications on the $4 generic drug program lists can be substituted for your current prescription medications. The medications offered under most of these programs cover most diseases and most chronic conditions such as arthritis, heart disease, high blood pressure, high cholesterol, depression, osteoporosis and diabetes.
Q: How do I know if it is possible for me to take advantage of the $10 offer for a 90-day supply of my medication?
A: Specific plan benefits vary: common criteria may be whether you are established on your medication for an extended period of time and/or if it is a maintenance medication. Because of the variances, you may always want to ask your pharmacy to try to process a claim for a 90-day supply in order to save you time and money.
Another option is to contact your prescription drug Customer Service Center at 800.546.5677 (TTY 866.706.4757) 24 hours a day, 7 days a week, to inquire about the provisions in your specific drug benefit program.
Q: Why should I use my prescription drug card and not just pay the pharmacy’s cash price when purchasing
these generics?
A: Your prescription drug card does more than assure you are receiving the lowest price available on your drug claim. These additional benefits and programs are built into the NPS Network SmartCard and are activated when you present the card at the pharmacy:
Drug Interaction Checking
Your prescriptions are screened and checked against other prescriptions you have had processed for possible drug-drug interactions or therapeutic drug problems. This serves as an added safety feature by alerting your pharmacist of these possible issues and is especially important if you do not always use the same pharmacy.
Maximum Benefit Accumulators
By presenting your card, all your payments – including your $4 generic payments – will apply to your drug card deductible and out-of-pocket maximum, if applicable. Additionally, if you have a Health Savings Account (HSA) or High Deductible Health Plan (HDHP), this centralized tracking of all your claims can ensure that your benefit is accounted for in a timely manner.
Prescription Drug Explanation of Benefits Report
If your plan provides you with a Prescription Drug Explanation of Benefits (EOB) report, you will be assured all your prescription drug purchases, including your $4 generics, will be included on the report when you present your prescription drug card with every prescription purchase. The EOB provides valuable information that you can share with your healthcare provider, utilize for tax purposes, and assist with your Flexible Spending Account (FSA) substantiation SM .
From an article published by National Pharmaceutical Services (NPS), HNE’s pharmacy provider.
©Copyrighted by Pharmaceutical Technologies, Inc. 2009.
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