policywunk
Guru
- 542
Where do you get carrier contracted drug cost on ACA plans before deductible is met?
Where do you get carrier contracted drug cost on ACA plans before deductible is met?
- Thread starter policywunk
- Start date
Good luck with that one. Client can probably get it from SOME carriers in their customer portal. Or, you will find out at the pharmacy shocker window
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- #3
policywunk
Guru
- 542
do you know if coupon cards that consumers can get when on an employer plan for brand name drugs ( farxiga,januvia,eliquis) are available for aca plans? If not do you know if someone can continue using discount for the rest of the year if they re-qualify for it in january 2023 while still on under employer coverage then transition to aca in February 2023?
There’s not an answer to this one.
You can’t get that from the carrier. (And it’s a closely guarded secret by the PBM’s)
The contract between the carrier/PBM and pharmacy will read X% of Average Wholesale Price plus a dispensing fee. BUT if the pharmacy acquisition cost is less, then the client pays less. Acquisition cost is based on pharmacy contracts with drug manufacturers.
Drug costs are based on a triangle of contracts that all work together.
For consumers, have them use GoodRX. It will at least give them a guesstimate. But a firm answer isn’t happening
You can’t get that from the carrier. (And it’s a closely guarded secret by the PBM’s)
The contract between the carrier/PBM and pharmacy will read X% of Average Wholesale Price plus a dispensing fee. BUT if the pharmacy acquisition cost is less, then the client pays less. Acquisition cost is based on pharmacy contracts with drug manufacturers.
Drug costs are based on a triangle of contracts that all work together.
For consumers, have them use GoodRX. It will at least give them a guesstimate. But a firm answer isn’t happening
Coupon cards can be used for anyone on an Under 65 policy.
Most coupon cards require that the drug be covered under the insurance but may transition with a new plan. Or they may not. TIP: Fill it on 1/31. Tell the pharmacy to run the RX again on 2/1. It’s not refill too soon because it’s a new insurance company. That gives the client 30 days to get it fixed.
And don’t forget…most coupon cards do not apply to the accumlators
