Cap on Meds
- Thread starter Bitnis
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schoolofhardknocks2
Expert
It is a 2k aggregate. All BCBSNC plans include rx coverage with this limit for name brand drugs. I agree that there are many combinations of drugs that could exhaust this limt. Not looking to argue that point. However, having coverage for drugs over $500/30 day supply protects the insured from a majority of catastrophic drug costs. I can tell you from my personal book of business this has been a non issue. Though I do have a few clients who are currently or have in the past been on drugs that cost in excess of 2-3k/month.
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- #14
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- #16
Yes there are many plans available that don't have RX limits.
I can't find it anywhere on BCBSNC website where they cover any prescription over $500 for a 30 day supply for INDIVIDUAL plans. All I see is a $2k max. Group policies can be customized so those are different. Whether or not it's in the policy, I would not know.
It still walks like a duck.
I can't find it anywhere on BCBSNC website where they cover any prescription over $500 for a 30 day supply for INDIVIDUAL plans. All I see is a $2k max. Group policies can be customized so those are different. Whether or not it's in the policy, I would not know.
It still walks like a duck.
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- #18
I agree.
I can't see putting myself in the position of having recommended such a plan and I would hate to be the one with the plan. Ohhh, that's right I was one who had such a plan, and got caught.
I'm guessing it has to do with selling plans and price. In my state it seems as though it's acceptable with BCBS and Wellpath being so popular.
I can't see putting myself in the position of having recommended such a plan and I would hate to be the one with the plan. Ohhh, that's right I was one who had such a plan, and got caught.
I'm guessing it has to do with selling plans and price. In my state it seems as though it's acceptable with BCBS and Wellpath being so popular.
Caps on Rx benefits are the only major drawback I have found with BCBS in VA. Carefirst has a max of $1500 Rx benefit (but their rates suck and customer service is horrid, so I don't push them much). Anthem has a max of $5k/year, but on the FlexChoice they cap the client OOP cost on specialty drugs (i.e. Level 4 types) at $10k per year with a max of $500 per script.
Humana has unlimited Rx and UHC has unlimited Rx with an optional rider, but Humana's coverage is not as broad as Anthem and UHC wants to put exclusion riders on just about everything, so they can be a tough product to make work for most people. Anthem is the only carrier we sell with maternity benefits, their rate increases tend to be less than other carriers, they cover all pre-existing conditions from day 1 if the person has creditable coverage (no exclusion riders), their rates are usually better than the competition, and there is no coinsurance after deductible on the $2500+ deduct. levels, which none of the other carriers offer on their copay plans. I have found that most people are comfortable with the Rx cap of $5k given those circumstances, though I always explain it in detail.
Humana has unlimited Rx and UHC has unlimited Rx with an optional rider, but Humana's coverage is not as broad as Anthem and UHC wants to put exclusion riders on just about everything, so they can be a tough product to make work for most people. Anthem is the only carrier we sell with maternity benefits, their rate increases tend to be less than other carriers, they cover all pre-existing conditions from day 1 if the person has creditable coverage (no exclusion riders), their rates are usually better than the competition, and there is no coinsurance after deductible on the $2500+ deduct. levels, which none of the other carriers offer on their copay plans. I have found that most people are comfortable with the Rx cap of $5k given those circumstances, though I always explain it in detail.
And most people have no clue how much meds can run.
It is your job as a professional agent to educate your client rather than taking orders.
Would you sell a plan with a $5,000 cap on surgery or hospital admission?
Same thing except more folks take meds than have surgery or end up in the hospital.
I love to come behind agents who sell plans with caps. Makes my job so much easier.
