Drug Coverage Closed Formulary Vs Open Formulary

[infoseeker]

Drug Coverage Closed Formulary vs Open Formulary is the question. Whats the difference? I understand that Assurant is one of the only companies that offers a open formulary when most other carriers offer a closed formulary . I called Assurant and no one can explain to me how the client would benefit from an open formulary .

I thought it was simple as explaining an HMO vs PPO . You cant go out of network with a HMO without paying full cost but with a PPO you can and pay a %. Apparently i cant get any answers that explain how if a client has a prescription for the drug that is not on the formulary how they would benefit by having a open formulary. would it mean the insurance company would cover some of the cost of the drug while others don't.

Does anyone have a handle on this?

 

[RayNY]

Specialty Pharmaceuticals

Please refer to this link for Assurant's page on their open formulary.

Moral of the story? Uncovered specialty medication is not sold to clients at retail, but rather, at the CVS Caremark negotiated rate so long as it's FDA approved and Prior Approval was obtained with the carrier and it's purchased through CVS/Caremark.

I don't know of a carrier with an explicitly "closed" formulary. If the patient needs it, the doctor prescribes it, the FDA approved it, the PBM stocks it, and PA was requested from the carrier, some concession is usually made as far as cost goes.

This isn't like a PPO vs. HMO, more like a HMO vs. HMO that lets doctors refer you out of network with prior approval at a reduced fee from retail.

 

[Yagents]

I don't know for certain (rarity), but an open formulary means you are not forced to take the generic version, or that the carrier will only "pay" for the generic versioin. (Closed formulary). Open, means you can take and they will cover the brand version of that drug (subject to prior auth and step therapy if it falls in that category)

Ex: AZ blue requires the generic version if available.

Open formulary also means a bigger list of meds in each category.

Assurant's drug formulary is the best in the biz.

 

[TxOnline]

Call your Sales Rep.
The sales reps talked about Open Formulary in the 2015 meetings.
My notes from the meeting say:
- Open Formulary
- No Rx limitations

The sales reps at the meeting said to call them with any questions about ANYTHING.
There are sales reps in the WI office that are well informed & helpful.
If one doesn't know the answer, they'll ask an associate....
....and provide your answer within minutes.

Here are a few numbers to try:
877-901-0400 Option 1 - Marisol Carter
877-901-0400 Option 2 - John Majowski
877-901-0400 Option 3 - Ever Martinez
If they're not the right reps for your state, ask them to give you the right number (or transfer you over to your rep).

 

[FLM2]

I don't know for certain (rarity), but an open formulary means you are not forced to take the generic version, or that the carrier will only "pay" for the generic versioin. (Closed formulary). Open, means you can take and they will cover the brand version of that drug (subject to prior auth and step therapy if it falls in that category)

Ex: AZ blue requires the generic version if available.

Open formulary also means a bigger list of meds in each category.

Assurant's drug formulary is the best in the biz.

Absolutely the best, period, it's made more than one sale for me to see a med that a client has been paying upwards of $150 listed under 'Preferred Brand' for either a $25 or $35 copay with no separate deductible.

 

[Yagents]

Absolutely the best, period, it's made more than one sale for me to see a med that a client has been paying upwards of $150 listed under 'Preferred Brand' for either a $25 or $35 copay with no separate deductible.

Lovin' that Silver 2 plan ............

 

[FLM2]

Lovin' that Silver 2 plan ............

For Off Exchange clients Silver 004 is even better-first $500 of labs covered at 100%, premium about 4% higher than Silver 002 (usually $10-15 a month) and slightly lower deductible.