Prescription Only Plans

Some health insurance companies have made it possible to have a stand-alone pharmacy plan, not integrated with other medical benefits. Unfortunately for us individual health plan advocates, these plans tend to only be available for individuals who are part of the Medicare Part D program, and a group plan. AARP MedicareRx plans are offered through UnitedHealthcare for Medicare Part D beneficiaries, and Coventry is a Medicare-approved sponsor of pharmacy benefits as well through their First Health Part D plan. Other companies include Aetna and Humana who provide their own separate prescription coverage program through a business setting.

As far as individual policies go, the major insurance companies offer a discount card as an additional benefit, as obviously not all medical plans cover prescription drugs. This is the best they can do to offer a separate plan, which seems a bit discriminatory against the individual market. Most likely due to the fact that more capital can be generated through pharmacy plans when covering hundreds of workers, the individual option might end up costing these companies more than they are willing to shell out. Another possibility is that providing a blanket option for a decent number of employees costs them less in the long run than offering such a benefit to individuals and families.

Individual Health Plan Solution: Discount Cards

Nearly every major health insurer offers a pharmacy discount card to individual plan members. The benefits range based on the company. For example, Aetna’s discount cards provide up to 30% off the average wholesale cost of prescription drugs. These discount cards are by no means a separate insurance plan, only what they sound like – a way to get a few dollars off at the pharmacy. While still helpful, the benefits sometimes pale in comparison to having integrated coverage. It all depends on the level of prescription you are purchasing and also the type of card you have. The Aetna discount card also connects members with potentially (the network varies with which card you have) over 53,000 participating pharmacies, both retail franchise and independent.

These cards give you discounts at selected pharmacies depending on who is in the insurer’s network, which typically is all major retail pharmacies. Golden Rule (UnitedHealthOne) also offers a discount card and preferred price card for pharmacy benefits, although the majority of their plans include prescription coverage on some level. Some company websites even include a disclaimer that you take note of how much more money is saved by using an integrated plan. Other companies do not participate, perhaps as an incentive to get more individuals to simply go with a health care plan including coverage on prescription drugs. This makes more sense from the business end, yet is somewhat inconvenient for the penny-pinching health care consumer.

It may also make more sense to an individual receiving health care to bundle all the benefits together, but as not all plans include prescription coverage – typically the value plan options. If a value plan member of a certain company happens to only be able to afford their low cost plan and it does not provide coverage on prescriptions, how will they be able to pay for treating an illness with a prescription medication if not covered? The best plan of action is to thoroughly research the plans and the companies in your area, examining the benefits before settling on the one with the lowest price. Health insurance is all about planning for the unexpected, having a back-up in case of emergency. Therefore, it is pertinent to check the prescription coverage, or lack thereof, and plan ahead if you need a discount card.

Group Coverage

Aetna and Humana both offer stand-alone prescription plans to anyone under an employer-sponsored plan. Each company gives several options for this type of coverage in a group health insurance setting, though the employer chooses the plan on your behalf. If you are an employer shopping for a pharmacy only plan, Aetna provides prescription drug coverage in many levels, starting with traditional one, two and three tier plans with varying copayment options to set up the proper costs align with your budget. Also offered are several fund plans, which bring a traditional pharmacy benefit to new potential by giving policy holders the opportunity to manage their own fund. PharmacyFund plans include a prescription drug plan, a fund and a deductible to better emphasize the importance of saving money at the pharmacy by allowing individuals to track spending personally. Humana also offers pharmacy only coverage for businesses with various types of plan designs. They also offer a home delivery option, giving discounts on services, but only with employer-based coverage.

Medicare

AARP and UnitedHealthcare make a pretty strong team when it comes to providing Medicare patients with prescription coverage. Anyone eligible for Medicare can use these plans even if they are not an AARP member. AARP gives Part D recipients access to a network of over 60,000 pharmacies nationwide, two types of plans with zero annual deductible, and the use of both generics and brand names. Coventry, Aetna, Kaiser Permanente, Cigna and our other insurers of choice also offer similar Medicare Part D plans. For Coventry’s Medicare plan, you must meet certain criteria, such as being a Part A or Part B member and living in one of their specified service areas. Members of an HMO, PPO, or Medicare Advantage Fee-For-Service plan that includes prescription coverage do not qualify for their particular plan. Other companies operate similarly, as Medicare is run very strictly in most cases as a government program. However, Medicare recipients do have an advantage over the non-Medicare-eligible majority in respect to pharmacy benefits.