Inside Iowa State: Iowa State University

January 16, 2004

Prescription drug co-pay rates change Feb. 1

by Linda Charles
Changes in the ISU Plan, including increased prescription costs, go into effect Feb. 1. Although it is too late to change the plan you have, there still are some things you can do to hold down your costs.

Diane Muncrief, benefits manager, suggests filling any prescriptions that are ready to be renewed before the end of January. Under current ISU Plan coverage, the prescription co-pay is $7 for generic drugs, $15 for preferred brand drugs and $30 for non-preferred brand drugs, regardless of the actual cost of the drug.

Under the new plan, which begins Feb. 1, you will pay $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. Lists (by health plan) detailing which drugs are generic, preferred or non-preferred are on the ISU benefits Web site (under "P&S, Faculty and Supervisory Merit" click on "Medical Plan").

You'll still be able to get three months of maintenance drug prescriptions for the cost of two. If you're on the Indemnity or PPO, your bill for three months of a preferred drug will show up as two charges of 30 percent of the actual cost of the drug. HMO participants' bills will show three charges of 20 percent of the cost of the drug. The total cost is the same for participants of all three plans, Muncrief said.

Shop around
Starting in February, Muncrief said, it may pay to shop around for the pharmacy that sells your medication at the lowest price. And you may want to check with your doctor to see if it's possible to change any of your medications to generic drugs. If you're among the 123 people who switched from the Indemnity plan to the PPO, you can save some money by waiting until February to have routine medical services, Muncrief said. Charges incurred during January while you're still in the Indemnity plan will be applied to the plan's $300 deductible. There is no deductible under the PPO for care from an in-network provider.

Those who changed insurance providers will receive new insurance cards prior to Feb. 1.

Medical "flex" accounts
ISU employees who started a health care flexible spending account this year will receive an information packet this month. If you're on the Indemnity or PPO plan, your Flex packet will include a form to provide direct deposit of Flex payments into your checking account. You also can sign up to be reimbursed for out-of-pocket expenses, with no need to file paperwork.

Remember that some over-the-counter drugs used primarily for medical care can be paid with Flex funds. You'll need to submit a reimbursement claim and attach a receipt that clearly states the name of the drug, the date purchased and amount paid. In some cases -- for example, vitamins that can be taken for general health purposes or medical reasons -- you may need a written statement from a medical practitioner stating the drug is recommended to treat a medical condition.

Your insurance company also can answer questions about coverage.