Silver Script 2019

[vic120]

I am getting a lot of calls (Guess they all waiting till AEP to call me on this)

But they are all sending me pages of explanation of benefits to show me that the ins company paid nothing on meds

I look up meds and they all show full cost to be much more then what was paid, However the explanation of benefits looks like SS paid nothing

What's the deal with that?

 

[StephanieCJ]

Each company negotiates price with both pharmacies and manufacturers. One example that happened when I looked at a drug plan for someone yesterday...
She takes Prednisolone eye drops. For most plans next year, the negotiated retail cost with the manufacturer (not her copay) is just over $40, but for one plan, it was $14 ish. If she fills that drug every month next year, because it is less than the copay for the tier on which they have placed it, the EOB will look like they’ve done nothing for her. In reality, having that negotiated lower retail price still helped her cost.

It is very similar to these ACA plans with the $6k deductible. To meet that deductible, you are not paying the full price charged by the doctor, but the price the insurance has negotiated with the doctor.