MEDS FOR little BUCKS!

Here is a website where you can research the popular $4.00 list for medications. It's a really great site to find out if your prescriptions are on $4 list and at what stores. Happy savings!

medtipster.com

Lipitor Gone Generic

Lipitor generic, Atorvastatin, has been added to the drug list with Anthem as of November 30, 2011.  This generic is tier 1 and will be a significant savings for members if they choose to take the generic. The tier 1 with Anthem is the lowest co-pay for members.  As always, members would want to consult with their Physicians if the generic would be suitable for them to switch to.

Also, Anthem announced the name brand, Lipitor, as of December 5, 2011, has moved to tier 3. Depending on the plan members are enrolled in, the full cost of the name brand could be the member's cost. Members are advised to check on the particular drug benefit they have to determine how this will impact them.

If you have any questions or need more information on this the Anthem website is a great tool to utilize for any drug changes with Express Scripts or you can always contact Customer Care with McGohan Brabender and we’ll be happy to assist.

Find help with the cost of Medicine

Our team received a “tip” on this site and it was too good not to share!  In our opinion this is one of the best sites found so far!  Below is link to a source of discounts, coupons, and so much more for prescription medication.  This site can help with all ages and even someone without insurance benefits.  We are very excited about finding this website and it is truly worth a look!

NeedyMeds.org

Update: Express Scripts/Walgreens Negotiations

Express Scripts, the company that administers [Anthem/Empire/UniCare]’s prescription drug Plan has been notified by Walgreens of their intention to leave the network when the contract expires on December 31, 2011.  The parties are still in negotiations and Anthem hopes to have this signed by the end of the year.

We have heard that Walgreens is informing customers of their intention to terminate the relationship at the end of the year with letters.  

Below you will find a Q/A sheet that Anthem has distributed.  Please feel free to use this information as warranted.  As we have more information to share, we will continue to update this blog.

Thank you

Anthem FAQ

Top 5: Causes of Changing Prescription Costs #1

1. How often your prescription plan carrier reviews the pricing of medications

The price of prescription medications is constantly changing based on a variety of factors. Anthem has compared the rise and fall of prices to gas or hotel rooms. The frequency that your insurance carrier audits the cost of prescriptions can mean significant impact for you.

For instance, some carriers only check the price of medications on a bi-annual basis while others check on a monthly basis. As a member, this can impact the total out of pocket throughout the year.

	Prescription Cost	Price to Member with bi-annual review	Price to member with monthly review
January	50	50	50
February	75	50	75
March	100	50	100
April	100	50	100
May	100	50	100
June	100	50	100
July *biannual review month	100	100	100
August	75	100	75
September	25	100	25
October	25	100	25
November	25	100	25
December	25	100	25
Total Cost		950	800

In this example, the member on the bi-annual plan has more consistency in their cost, but their final year out of pocket is $950. The member on the monthly review plan has costs all over the place, but their final year out of pocket is only $800. This can go either way for the member, but the frequency that the plan reviews this cost can impact the consistency of the prescription pricing as well as the out of pocket cost to the member.

For more examples of the causes of changing prescription costs, check out our Top 5: Causes of Changing Prescription Costs and check back often for articles explaining further each of these examples.

Top 5: Causes of Changing Prescription Costs

One of the more common questions that our team receives from our clients is: I just went to the pharmacy, and the cost of my medication nearly doubled from last month; what is going on?

Many factors can play into the cost of a prescription, but over the next few weeks, our team will be looking into what we see as the Top 5 Causes of Changing Prescription Costs. Keep checking in over the next few weeks for articles elaborating on the following causes:

1. How often your prescription plan carrier reviews the pricing of medications

2. Patents on medications and patent extensions

3. The availability of and introduction of generic medications

4. FDA approved uses of prescriptions

5. Manufacturer rebates and the net cost of a prescription to your plan

In the meantime, you can also check out the nice article that Anthem put together explaining some of these causes.

Top 5: Ways to Control the Cost of Healthcare #3

3. Opt for generic or lower cost drug alternatives when available

Many factors play into the costs of prescription medications: cost of ingredients, costs of research and development, patents, etc. Often, brand name prescriptions have an initial higher cost for healthcare consumers to offset the cost of developing the medications during the window of time when their patent allows for the company to have control over the distribution of the medication. After this time, other companies can create generic alternatives to the brand names.

As the US Food and Drug Administration states:

Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.

Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs. And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.

Since the companies creating the generic medications do not have to invest as significantly in the research and development of the medication, they can sometimes offer it at a discount rate.
While your primary decision on medications should be the advice of your physician, opting for generic or lower cost drug alternatives is another way to control the cost of your healthcare, and you can ask your provider about your options.

For more ways to control your healthcare costs, check out our Top 5: Ways to Control the Cost of Healthcare and check back often for articles explaining further each of these examples.

Top 5: Ways to Control the Cost of Healthcare

Healthcare can be expensive, whether you are on a high deductible health plan with an HSA, a PPO, or some other health care plan. As many plans are becoming consumer driven, it is important as a consumer to understand how to control the costs of your care.

While not every option works best for every person, the top five ways to control the cost of your health care are:

1.    Utilize in-network/participating providers with your plan

2.    Choose the right care facility (Primary Care Physician vs. Urgent Care vs. Emergency Room)

3.    Opt for generic or lower cost drug alternatives when available

4.    Ensure that your lab work is being completed by an in-network/participating lab

5.    Get pre-authorizations or predeterminations of benefits done when necessary

Check back to our blog often over the next few weeks for articles explaining how each of these options can help in controlling the cost of your care. Also, download our Top 5 Ways to Control the Cost of Healthcare checklist!

Top 10 Reasons Your HSA Does Not Match Your Deductible #1

1. Your prescriptions have not be submitted to your insurance

One of the most common reasons that HSA accounts do not match up with medical deductibles is because a prescription has not been run through the insurance (and therefore not applied to the deductible) but paid for with HSA funds. Whether a pharmacy has old insurance information, offer a cheaper generic alternative that is not submitted through insurance, or confuse running an HAS card (that has the insurance emblem on it) as running the charges through insurance, our team is seeing this as a common reason that deductibles and HSA accounts become uneven.

For instance, let’s say that you have a $1500 deductible and start the year with $1500 in your HSA account. You fall ill one evening and go to the hospital. The hospital examines and treats you, releasing you the next morning with even medication for a week. However, you have instructions to go get more medication once you are out. The hospital submits the claim for your visit and medication, and it processes towards your in network deductible for $1400.  You go to pick up your prescription, which your pharmacist tells you will cost $150. You pay with your HSA funds, leaving you with $1350 in your account, and go on your way. The next week, you receive the bill for the hospital stay. The bill is for $1400, but you only have $1350 in your account. It seems that your new pharmacist forgot to run your prescription through your insurance, leaving you with uneven HSA funds and deductible.

You go to the pharmacy and ask the pharmacist to reprocess your prescription through your insurance. They resubmit it, and find that you only owed $100 to meet your deductible. They refund the extra $50 to your account, leaving you with $1400 in your HSA. You are now able to pay for your hospital bill in full and have met your $1500 in network deductible.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Express Scripts and Walgreen's Contract

Recently, articles have begun to circulate regarding the negotiations of Walgreens and Express Scripts, the pharmacy provider network used by Anthem. Articles have included headlines such as Walgreens to Sever Ties With Express Scripts.

After contacting representatives from Express Scripts, McGohan Brabender has been told that:
This type of negotiation is common between pharmacy benefit managers and pharmacies. It's early in the process. There has been no change in our members' abilities to use their pharmacy benefits at Walgreens and Duane Reade pharmacies. The contract does not expire until January 1, 2012, giving the two parties several months to work out a solution. We are hopeful that Walgreen Co. and Express Scripts can soon reach a reasonable solution that meets our members' and customers' needs.

At this time, these negotiations should not effect the prescription benefits of an Express Scripts member going to a Walgreens pharmacy, but we will continue to communicate with our representatives and keep updates posted.

Top 10 Reasons Your HSA Does Not Match Your Deductible #6

6. You paid for non-covered benefits with your funds

While an HSA is a bank account, it is a very special account because it is funded with tax-exempt dollars. That means that these funds can only be spent of IRS declared qualified expenses. While this certainly includes medical claims that area applied to your deductible, this money can also be used to pay for such expenses as acupuncture and over the counter medications (so long as you have a prescription on file). However, in many cases these expenses are not eligible to be applied to your medical deductible. While you can pay for them with your HSA funds, you will end up with less money in your HSA than you must have to meet your deductible.

For instance, let’s say that you have a $1500 deductible and start the year with $1500 in your HSA. Since you have seasonal allergies, your physician has suggested that you get some Allegra in April. Although this is now an over the counter medication and cannot be run through your medical insurance, because the physician has written you a prescription, you are able to pay the $20 charges with your HSA funds. You now have $1480 in your HSA and $1500 left to meet on your deductible. When you have a bad fall on a run in May and break your ankle, you x-rays, casting, and crutches total claims of $1600. You insurance applies the first $1500 to you deducible and pays the remaining $100. You are responsible for the $1500, but you only have $1480 in your HSA. You may pay up to $1480 out of your HSA, but you will need to pay $20 out of pocket to meet you deductible.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Anthem Medications Moving From Tier 3 to Tier 4 7/15/2011

Anthem has recently announced that the following medications will be moving from a Tier 3 to a Tier 4 classification effective 7/15/2011:

Actemra

Acthar H.P.

Amevive

Cimzia

Egrifta

Ilaris

Incivek

Makena

Orencia

Prolia

Remicade

Simponi

Stelara

Sylatron

Thyrogen

Victrelis

Depending upon the policy of the member, this could change their out-of-pocket costs for their medications. Members impacted by this change will be receiving letters in the coming weeks which will suggest that they can:

• Continue getting their prescription from the pharmacy you’re using now, and your share of the cost will increase.
• Or speak to their doctor about the possibility of changing to another medicine that will cost you less

What should you do if your deductible, EOB, etc. does not match up with your HSA?

HSA accounts can be a great way to plan and pay for your medical expenses throughout the year. By offering you a tax-free option to pay for medical bills, prescriptions, and other qualifying expenses, you can get more out of your health care money.

Some individuals set up their plans so that they can cover the cost of their deductible with their HSA money. However, when their EOB and HSA balance do not match up or they run out of money before they meet their deductible, they are upset and confused. If you come across this situation, you will want to:

Aetna Pharmacy to No Longer Cover Allegra

Recently, the Food and Drug Administration approved Allegra as an Over-The-Counter medication. With this change, prescription Allegra , Allegra-D, and generic equivalents will no longer be covered under most Aetna Pharmacy benefits. As of March 4, 2011, these medications will be available over-the-counter.

Aetna members who filled a prescription for any of these medications or their generic equivalent between January 2010 and February 2011 will receive a letter from Aetna explaining this change as the medications will not longer be covered by Aetna's Pharmacy Benefits. Aetna's Preferred Drug List is subject to change. For up-to-date information, you can visit www.aetna.com/formulary or call the Member Services on the toll-free number found on your Member ID card.

Price Your Prescriptions!

When it comes to health care costs, no one wants a surprise. We can do our best to control costs by going to in network providers, understanding any exclusions on our plan coverage, and having our preventive screenings. Now, through your Anthem.com log in, you can price out your prescription medicine!