Inside Iowa State: Iowa State University

November 7, 2003

Prescription copay to change

by Anne Krapfl
ISU employees participating in the ISU Plan have through Friday, Dec. 5, to make changes to their plan coverage for the year that begins Feb. 1, 2004. Employees who want to keep the same benefits listed on the form mailed to participants last month don't need to do anything.

A notable change to the plan this year is in the copay structure for prescription drugs. This is due to the escalating cost of prescription medications. Health care service costs are expected to increase by 12 percent this year, but the projected increase for prescription drugs is nearly 20 percent.

Under current ISU Plan coverage, the prescription drug co-pay is a flat $7 for generic drugs, $15 for preferred brand drugs and $30 for non-preferred brand drugs, regardless of the actual cost of the drug.

As recommended by the University Benefits Committee, the new copay structure will be $10 for generic drugs, 30 percent of the actual cost for preferred brand drugs, and 50 percent of actual cost for non-preferred brand drugs.

The new plan also will include a $1,500 out-of-pocket maximum (per contract) for pharmacy purchases only. The pharmacy out-of-pocket limit does not apply to the out-of-pocket limit (for non-pharmacy services) for those participating in the PPO or indemnity plans.

Depending on the number and type of prescriptions participants need, the change could have a significant impact on out-of-pocket expenses. One option ISU benefits officials suggest is using a health care flexible spending account to help offset the increased cost to employees. "Flex" accounts let participants set aside funds on a pre-tax basis to cover up to $5,000 in non-covered medical expenses -- including prescription drug co-pays.

Two other changes worth noting in the ISU Plan:

Acupuncture is being added as a covered benefit for those enrolled in the HMO plan only. A $10 copay per visit is required, with a maximum annual benefit of $500 per person.
The copay for emergency room service in the PPO and HMO plans will increase, from $35 to $100. The copay is waived if the individual is admitted to the hospital.

During the enrollment period, ISU benefits staff will be available during two designated sessions to visit with ISU Plan participants and answer questions. They are:

Friday, Nov. 7, noon to 3 p.m., open session in 3150 Beardshear
Monday, Nov. 10, 12:30-4 p.m., Vendor fair of insurance companies providing medical coverage to ISU employees, in the MU Great Hall (ISU benefits employees also will attend).